Provider Demographics
NPI:1811306350
Name:TILLMAN, DANIELLE (LCSW, LADC, LADC-S)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:LCSW, LADC, LADC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 ESE LOOP323 # 227
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8337
Mailing Address - Country:US
Mailing Address - Phone:752-252-4087
Mailing Address - Fax:
Practice Address - Street 1:7400 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1112
Practice Address - Country:US
Practice Address - Phone:775-853-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16173101YA0400X
TX1072061041C0700X
NV12135-C1041C0700X
NV06736-S101YA0400X
NV01858-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)