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Johnny Lawrence Tillis
Student in an Organized Health Care Education/Training Program in Elk Grove, California
NPI 1528606829

Johnny Lawrence Tillis is a Student in an Organized Health Care Education/Training Program based in Elk Grove, CA. Johnny Lawrence Tillis practices in Elk Grove, CA. The NPI Number for Johnny Lawrence Tillis is 1528606829 and holds a License No. (California).

The current practice location address for Johnny Lawrence Tillis is 9412 Big Horn Blvd Ste 6, Elk Grove, CA and can be reached out via phone at 916-879-2574.

Location: 9412 Big Horn Blvd Ste 6, Elk Grove, CA, 95758-1101
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1528606829
Provider Name
Johnny Lawrence Tillis
Credential
Provider Entity Type
Individual
Gender
Male
Address
9412 Big Horn Blvd Ste 6, Elk Grove, CA, 95758-1101
Phone Number
916-879-2574
Fax Number
Provider Enumeration Date
12/17/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
9412 Big Horn Blvd Ste 6
City
Elk Grove
State
California
Zip
95758-1101
Phone Number
916-879-2574
Fax Number
person
Provider Business Mailing Address Details
Address
9412 Big Horn Blvd Ste 6
City
Elk Grove
State
California
Zip
95758-1101
Phone Number
916-879-2574
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
()
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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