Provider Demographics
NPI:1447279096
Name:TILLER, DANA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:TILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31769 NIMBUS DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2564
Mailing Address - Country:US
Mailing Address - Phone:830-357-9298
Mailing Address - Fax:
Practice Address - Street 1:29710 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3246
Practice Address - Country:US
Practice Address - Phone:830-357-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19414101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor