Individual
CHARLES L TILLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4642 BETHUME DR, SHREVEPORT, LA 71109-6634
(318) 532-2204
Mailing address
700 PIERRE AVE STE A, SHREVEPORT, LA 71103-2725
(318) 532-9214
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/26/2017
Last updated
06/26/2017
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