MEDICARE: MARSHA LS TILLES LCSW

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	1041C0700X	Clinical Social Worker	LCS24181	CA

General Provider Information

NPI Number	:	1558541722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA LS TILLES LCSW

Provider Business Mailing Address
First Line	:	7606 WILLOUGHBY AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-7432
Country	:	US
Telephone Number	:	310-490-6139
Fax Number	:

Provider Business Practice Location Address
First Line	:	9300 WILSHIRE BLVD
Second Line	:	STE. 306
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3213
Country	:	US
Telephone Number	:	310-746-5366
Fax Number	:

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

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	05/12/2010

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