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General NPI Number Information
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NPI Number | 1619318979
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Entity Type | Individual
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Provider Name | ASHLEY ANN TILLERY LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1173 W MAIN ST STE B
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City | WHITEWATER
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State | WI
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Zip | 53190-1672
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Country | US
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Telephone | 262-458-2525
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Fax | 262-458-2680
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Provider Business Mailing Address
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Address Line | 4229 W STATE ROAD 59
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City | EDGERTON
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State | WI
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Zip | 53534-9418
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Country | US
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Telephone | 715-572-5362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 11800-120
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1170-124
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License Number State | WI
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