Provider Demographics
NPI:1063110757
Name:SISNEROS, TILLARIE ELANA (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:TILLARIE
Middle Name:ELANA
Last Name:SISNEROS
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:TILLARIE
Other - Middle Name:
Other - Last Name:SISNEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TILLARIE JONES
Mailing Address - Street 1:100 N MCGEE ST STE 42
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4016
Mailing Address - Country:US
Mailing Address - Phone:806-231-3764
Mailing Address - Fax:
Practice Address - Street 1:100 N MCGEE ST STE 42
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4016
Practice Address - Country:US
Practice Address - Phone:806-231-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional