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NPI Code Detail

MEDICARE: TILGHMAN B EVANS LMSW

MEDICARE: TILGHMAN B EVANS LMSW
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
11041C0700XClinical Social WorkerM11053NM

General Provider Information

NPI Number : 1770257933
Entity Type Code : Individual
Provider Name (Legal Business Name) : TILGHMAN B EVANS LMSW
Provider Business Mailing Address
First Line : PO BOX 457
Second Line :
City : TAOS
State : NM
Zip : 87571-0457
Country : US
Telephone Number : 575-741-5141
Fax Number :
Provider Business Practice Location Address
First Line : 105 BERTHA RD STE B
Second Line :
City : TAOS
State : NM
Zip : 87571-7148
Country : US
Telephone Number : 575-741-5141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2021
Last Update Date : 08/02/2021

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Directions to “ TILGHMAN B EVANS LMSW” Practice Location

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