Michael Alan Tyllas, LCSW, PH.D.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149005514 Issued in IL

Practice address

1500 Sheridan Rd Unit 5L
Wilmette, IL 60091-1892

Phone

(773) 550-6022

NPI assigned

Jun 26, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624665600000",
    "number": "1023688728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SHERIDAN RD UNIT 5L",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911892",
            "telephone_number": "773-550-6022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SHERIDAN RD UNIT 5L",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911892",
            "telephone_number": "773-550-6022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYLLAS",
        "first_name": "MICHAEL",
        "middle_name": "ALAN",
        "credential": "LCSW, PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-26",
        "last_updated": "2021-06-26",
        "certification_date": "2021-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149005514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDFPR LICENSE",
            "identifier": "149005514",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Demetrius Trakas, M.D.
• Heather Troester, MA
• Jaime Trujillo-Gomez, MD
• Celeste Vaughn Twombly
• Jacqueline Tworek
• Daniela Uy Kimpang
• Lindsay Wegg Uzunlar, MD
• Hina R Valiani, APRN
• Pieter A Van Heule, D.C.
• Allison Field Vanhorn, ATC

• Clinical Social Worker in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.