Provider Demographics
NPI:1194061382
Name:TILLMAN, MEGAN (LMFT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 BEMISS RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7014
Mailing Address - Country:US
Mailing Address - Phone:229-586-6082
Mailing Address - Fax:229-922-9394
Practice Address - Street 1:3310 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7014
Practice Address - Country:US
Practice Address - Phone:229-586-6082
Practice Address - Fax:229-922-9394
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist