Provider Demographics
NPI:1316067036
Name:TILLER, DONNA S (PHD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:S
Last Name:TILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16715 LILLY CREST DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2303
Mailing Address - Country:US
Mailing Address - Phone:210-472-6590
Mailing Address - Fax:210-472-6599
Practice Address - Street 1:16715 LILLY CREST DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2303
Practice Address - Country:US
Practice Address - Phone:210-490-9840
Practice Address - Fax:210-472-6599
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5997101YA0400X
TX6386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional