Travon Di Angelo Tillis

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

ASW104373 Issued in CA

Practice address

625 Fair Oaks Ave
300
South Pasadena, CA 91030-2630

Phone

(626) 395-7100

NPI assigned

Apr 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1740407576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S BEAUDRY AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171466",
            "telephone_number": "213-241-3841",
            "fax_number": "213-241-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 FAIR OAKS AVE",
            "address_2": "300",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910302630",
            "telephone_number": "626-395-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLIS",
        "first_name": "TRAVON",
        "middle_name": "DI ANGELO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW104373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jay R Thomas, MD
• Eliza A. Thompson, MS, CCC-SLP
• Karla Guinn Thompson, DDS
• Elaine Thornton, D.C.
• Thrifty Payless Inc (Rite Aid Pharmacy 05531)
• Timothy Samkit Tin, L.AC.
• Tina Marie Therapy, Licensed Clinical Social Worker, Inc.
• Nancy Tinajero-Guerrero
• Tishangi Kumar Agrawal MD
• Tom a. Eisenberg, PH.D. (Huntington Behavioral Health)

• Mental Health Counselor in South Pasadena, CA
• Providers in South Pasadena, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; 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.