Candace Lynn Tillery, LMSW, CAADC, SAP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801099467 Issued in MI

Practice address

3721 W Michigan Ave Ste 200
Lansing, MI 48917-3600

Phone

(517) 515-6176

Fax

(517) 515-6176

NPI assigned

Mar 25, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Candace Lynn Buckner Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Innovative Behavioral Solutions

  • Clinical Social Worker
  • Lansing, MI
  • NPI 1396128088
  Medicare reassignment Authorized official
• Innovative Behavioral Health

  • Clinic/Center
  • Lansing, MI
  • NPI 1164035051
  Medicare reassignment NPD
• Community Behavioral Health Authority

  • Community/Behavioral Health Agency
  • Lansing, MI
  • NPI 1265912281
  Authorized official Same address or phone
• Innovative Home Health Services

  • Home Health Agency
  • Lansing, MI
  • NPI 1336754571
  NPD

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

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1114389301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 W MICHIGAN AVE STE 200",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489173600",
            "telephone_number": "517-515-6176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 W MICHIGAN AVE STE 200",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489173600",
            "telephone_number": "517-515-6176",
            "fax_number": "517-515-6176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLERY",
        "first_name": "CANDACE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LMSW, CAADC, SAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-25",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "C-03445",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801099467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDACE",
            "last_name": "BUCKNER",
            "middle_name": "LYNN",
            "credential": "LMSW, CAADC, SAP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alana Thurman
• Cassidy Thurmond, LLMSW
• Jaymie Tibbits, LLMSW
• Stephanie Tighe, CSW
• Valerie Tijerina, LLPC
• Ricardo David Tillery, MBA, LMSW, ICAADC
• Anisha Timilsina, MD
• Haylee Tincher
• Breeyn Tinkle
• Domonika Sharee Tipton, LMSW

• Clinical Social Worker in Lansing, MI
• Providers in Lansing, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.