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Individual
TILLARY TICE
Active
Individual
TILLARY TICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
66536
TX
1041C0700X
Clinical Social Worker
118829
IA
1041C0700X
Clinical Social Worker
C013683
NC
1041C0700X
Clinical Social Worker
Primary
CSW.09928294
CO
1041C0700X
Clinical Social Worker
P013179
NC
1041C0700X
Clinical Social Worker
TPSW753
NH
1041C0700X
Clinical Social Worker
TPSW753
TX
Other
Enumeration date
06/11/2019
Last updated
03/04/2026
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