Individual
AMANDA LYNN TILLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6609 S 112TH EAST AVE, TULSA, OK 74133-2630
(918) 709-5292
Mailing address
6609 S 112TH EAST AVE, TULSA, OK 74133-2630
(918) 709-5292
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/20/2012
Last updated
09/20/2012
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