Individual provider Active NPI

Felisha A Tillman, LPC

  • Professional Counselor
  • Dyersburg, TN
National Provider Identifier
1194533877
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
7703 Issued in TN
Practice address
2380 Henry St
Dyersburg, TN 38024-1847
Phone
(731) 882-4728
Fax
(731) 287-1795
NPI assigned
Dec 26, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 7703 TN Primary

Addresses

Primary practice location

2380 Henry St
Dyersburg, TN 38024-1847

Mailing address

615 Vaughn Ave Apt D
Dyersburg, TN 38024-3089
Phone (731) 882-9175

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20250213000141 TN Practitioner - Mental Health Counselor 2567992035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Professional Care Services of West TN, Inc.Group PAC ID 0042115537, 12 clinicians

Practice addresses (Care Compare)

213 Lakeview Rd
Somerville, TN 38068-9744
Phone (844) 727-2778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Care Services of West TN, Inc. CurrentSince Jan 1, 2025 Accepting new patients

Locations

1997 Highway 51 S
Covington, TN 38019
Phone (844) 727-2778

2380 Henry St
Dyersburg, TN 38024
Phone (731) 287-1794

5281 Navy Rd
Millington, TN 38053
Phone (901) 407-2944

403 Commerce St
Ripley, TN 38063
Phone (731) 635-3968

213 Lakeview Rd
Somerville, TN 38068
Phone (844) 727-2778

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1735171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1194533877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 VAUGHN AVE APT D",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243089",
            "telephone_number": "731-882-9175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 HENRY ST",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241847",
            "telephone_number": "731-882-4728",
            "fax_number": "731-287-1795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "FELISHA",
        "middle_name": "A",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-26",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "7703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dyersburg, TN

Sources for this page

Verify at the official NPI Registry.