Sitthivanh Tilley, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

84929 Issued in TX

Practice address

1717 W 10TH St
Austin, TX 78703-3907

Phone

(512) 472-4357

NPI assigned

Sep 18, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Sitthivanh Manivong Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake Worth Counseling

  • Mental Health Counselor
  • Fort Worth, TX
  • NPI 1194085506
  NPD (past)

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611360000000",
    "number": "1083133375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 W 10TH ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787033907",
            "telephone_number": "512-472-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 W 10TH ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787033907",
            "telephone_number": "512-472-4357"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "827 W Harvard St",
            "address_purpose": "LOCATION",
            "city": "Siloam Springs",
            "state": "AR",
            "postal_code": "727614013",
            "country_code": "US",
            "telephone_number": "479-549-3121",
            "fax_number": "479-750-4843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLEY",
        "first_name": "SITTHIVANH",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-18",
        "last_updated": "2021-01-23",
        "certification_date": "2021-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A1801003",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "84929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SITTHIVANH",
            "last_name": "MANIVONG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Leah Tillas
• Marie Tillema, PHARM.D.
• Ada S Tiller, D.D.S.
• Jennifer L Tiller, APRN, CPNP-PC
• Evita Tilley
• Laurel Ann Tillman
• Rachael Tillman
• Saulette Raquel Tillman, M.D.
• Timbre Health LLC
• Brody Timm

• Professional Counselor in Austin, TX
• Providers in Austin, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.