MEDICARE: BRITTANY JEANNE TILBERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6659	SC

General Provider Information

NPI Number	:	1538630405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY JEANNE TILBERRY

Provider Business Mailing Address
First Line	:	466 DANDELION LN
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4126
Country	:	US
Telephone Number	:	843-504-9972
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6810
Country	:	US
Telephone Number	:	843-504-9972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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