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Organization

AT4K TEXAS PROVIDERS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRIS TILLOTSON (CEO)
(248) 770-9929
Entity
Organization

Contact information

Practice address
1100 S MAIN ST STE 103, GRAPEVINE, TX 76051-7531
(817) 310-5510
Mailing address
112 WALNUT BLVD UNIT 308, ROCHESTER, MI 48307-2317

Taxonomy

Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
2080P0006X
Developmental - Behavioral Pediatrics Physician

Other

Enumeration date
01/08/2025
Last updated
02/07/2025
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