Provider Demographics
NPI:1851616239
Name:TILLEY, REBECCA L (PSY D)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:TILLEY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:SCHLAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:2101 OLD CONGO RD
Mailing Address - Street 2:SUITE F900
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-794-6557
Mailing Address - Fax:501-794-6545
Practice Address - Street 1:2101 OLD CONGO RD
Practice Address - Street 2:SUITE F900
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-794-6557
Practice Address - Fax:501-794-6545
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10-04P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR10-04POtherLICENSE