Jay El Tillman

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

RS2684 Issued in CA

Practice address

6885 Old Hwy 53
Clearlake, CA 95422

Phone

(707) 995-3235

NPI assigned

Nov 7, 2007

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

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 County Community Action Agency

  • Community/Behavioral Health Agency
  • Clearlake, CA
  • NPI 1215125026
  NPD (past)
• Lake County Community Action Agency

  • Community/Behavioral Health Agency
  • Clearlake, CA
  • NPI 1669677886
  NPD (past)

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194393600000",
    "number": "1154501047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6840 S CENTER DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228134",
            "telephone_number": "707-995-1232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6885 OLD HWY 53",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "95422",
            "telephone_number": "707-995-3235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "JAY",
        "middle_name": "EL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RS2684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nichealle Mylenda Thies
• Jayme Thomas
• Alexis Thompson, PA-C
• Janet Lynn Thomson, RRW- 0106
• Thrifty Payless Inc
• Milagros Tolentino, MD
• Summer Maree Trongo
• Elsa M Valdivia, MD
• Krista Ann Van Vranken, BA MPA
• Kimberland Dale Vanhorn, RASI

• Addiction (Substance Use Disorder) Counselor in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; 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.