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General NPI Number Information
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NPI Number | 1720028590
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Entity Type | Individual
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Provider Name | JULIA TILLIE L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 3840 HULEN ST HTN, CLIENT ACCOUNTING
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City | FORT WORTH
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State | TX
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Zip | 76107-7277
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Country | US
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Telephone | 817-569-4913
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Fax | 817-569-5098
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Provider Business Mailing Address
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Address Line | PO BOX 2603
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City | FORT WORTH
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State | TX
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Zip | 76113-2603
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Country | US
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Telephone | 817-569-4913
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Fax | 817-569-5098
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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 | 42040
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 42040
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License Number State | TX
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