Individual
MACY A TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7211 E 131ST ST, GRANDVIEW, MO 64030-3318
(816) 204-6654
Mailing address
7211 E 131ST ST, GRANDVIEW, MO 64030-3318
(816) 204-6654
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2022014801
MO
1041C0700X
Clinical Social Worker
LSCSW05829
KS
Other
Enumeration date
10/19/2022
Last updated
10/19/2022
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