Active NPI
Suzanna Marie Tillotson, PH.D.
- Marriage & Family Therapist
- Boise, ID
National Provider Identifier
1154533164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT - 11
- Practice address
- 1701 N Beach St
#2
Boise, ID 83706-1117 - Phone
- (208) 672-8130
- Fax
- (208) 672-8130
- NPI assigned
- May 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT - 11 | ID | Primary |
| Marriage & Family Therapist | 106H00000X | 116424-3902 | UT |
Addresses
Primary practice location
1701 N Beach St
#2
Boise, ID 83706-1117
Mailing address
3257 Catalina LN
Boise, ID 83705-4006
Phone (208) 672-8130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT - 11 | ID | MD | Marriage & Family Therapist |
| 116424-3902 | UT | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154533164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3257 CATALINA LN",
"city": "BOISE",
"state": "ID",
"postal_code": "837054006",
"telephone_number": "208-672-8130",
"fax_number": "208-672-8130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 N BEACH ST",
"address_2": "#2",
"city": "BOISE",
"state": "ID",
"postal_code": "837061117",
"telephone_number": "208-672-8130",
"fax_number": "208-672-8130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLOTSON",
"first_name": "SUZANNA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "ID",
"license": "LMFT - 11",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "UT",
"license": "116424-3902",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.