Individual
RUSSELL TILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
521 OLD HODGENVILLE RD, GREENSBURG, KY 42743-9493
(270) 932-3226
Mailing address
259 PARKERS MILL RD, SOMERSET, KY 42501-3152
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
763
KY
Other
Enumeration date
10/23/2008
Last updated
10/23/2008
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