Provider Demographics
NPI:1720633308
Name:TILLMAN, LENOX ASHTON (BCBA)
Entity type:Individual
Prefix:
First Name:LENOX
Middle Name:ASHTON
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LENOX
Other - Middle Name:
Other - Last Name:ASHTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:7441 114THE AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773
Mailing Address - Country:US
Mailing Address - Phone:727-492-5369
Mailing Address - Fax:727-544-5900
Practice Address - Street 1:7441 114TH AVE STE 604
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5124
Practice Address - Country:US
Practice Address - Phone:727-492-5369
Practice Address - Fax:727-544-5900
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2023-02-01
Deactivation Date:2020-10-05
Deactivation Code:
Reactivation Date:2020-10-14
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-23-63704103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician