Individual
MRS. PAMELA LYNN TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHP
Contact information
Practice address
3532 W CAPITAL AVE, GRAND ISLAND, NE 68803-1205
(308) 381-7487
(308) 381-2712
Mailing address
PO BOX 5858, GRAND ISLAND, NE 68802-5858
(308) 381-7487
(308) 381-2712
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9099
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098184
MEDICARE
NE
05
—
47077707526
—
NE
Enumeration date
03/10/2010
Last updated
03/10/2010
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