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General NPI Number Information
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NPI Number | 1720657547
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Entity Type | Individual
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Provider Name | JILLIAN R TUSO PHD, PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 10430 HARRIS OAK BLVD STE L
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City | CHARLOTTE
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State | NC
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Zip | 28269-7513
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Country | US
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Telephone | 704-317-2930
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Fax |
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Provider Business Mailing Address
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Address Line | 10430 HARRIS OAK BLVD STE L
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City | CHARLOTTE
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State | NC
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Zip | 28269-7513
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Country | US
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Telephone | 704-317-2930
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6572
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1680
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6572
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | SC
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