Individual
TILLARY BLAINE BLACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1700 W IRVING PARK RD STE 305B, CHICAGO, IL 60613-2462
(312) 585-6965
(877) 655-9891
Mailing address
3319 N SEELEY AVE, CHICAGO, IL 60618-6221
(872) 302-7123
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071010501
IL
Other
Enumeration date
08/07/2017
Last updated
11/09/2023
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