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NPI Code Detail

MEDICARE: DANIELLE TILLMAN LCSW, LADC, LADC-S

MEDICARE: DANIELLE TILLMAN LCSW, LADC, LADC-S
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
1101YA0400XAddiction (Substance Use Disorder) Counselor16173TX
21041C0700XClinical Social Worker107206TX
31041C0700XClinical Social Worker12135-CNV
4101YA0400XAddiction (Substance Use Disorder) Counselor06736-SNV
5101YA0400XAddiction (Substance Use Disorder) Counselor01858-LNV

General Provider Information

NPI Number : 1811306350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE TILLMAN LCSW, LADC, LADC-S
Provider Business Mailing Address
First Line : 1912 ESE LOOP323 # 227
Second Line :
City : TYLER
State : TX
Zip : 75701-8337
Country : US
Telephone Number : 752-252-4087
Fax Number :
Provider Business Practice Location Address
First Line : 7400 S VIRGINIA ST
Second Line :
City : RENO
State : NV
Zip : 89511-1112
Country : US
Telephone Number : 775-853-5441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2014
Last Update Date : 07/14/2025

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