Individual
MS. CRYSTAL M TILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
7850 ANSELMO LN, BATON ROUGE, LA 70810-1101
(225) 768-6537
Mailing address
7850 ANSELMO LN, BATON ROUGE, LA 70810-1101
(225) 768-6537
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
0000
LA
103TC0700X
Clinical Psychologist
Primary
1479
LA
103TC0700X
Clinical Psychologist
37666
TX
Other
Enumeration date
10/02/2013
Last updated
03/02/2021
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