Individual
CONLEY TILLMAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2624 LEXINGTON AVE, SPRINGFIELD, OH 45505-2620
(937) 328-5300
(937) 322-4900
Mailing address
2624 LEXINGTON AVE, SPRINGFIELD, OH 45505-2620
(937) 328-5300
(937) 322-4900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.162257
OH
104100000X
Social Worker
W.1800116
OH
171M00000X
Case Manager/Care Coordinator
CDCA.166069
OH
Other
Enumeration date
12/06/2018
Last updated
09/14/2021
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