Tillery, Ricardo David

Tillery, Ricardo David is an sole proprietor health care provider with primary practice located at 3721 W Michigan Ave Ste 200 , Lansing MI 48917-3600. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Behavioral Analyst, Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Tillery, Ricardo David can be contacted via phone (517) 515-6176.

Contact Information

Primary practice address
3721 W Michigan Ave Ste 200 Lansing MI 48917-3600
Phone: (517) 515-6176
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X C-02622 Michigan
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X
Behavioral Health & Social Service Providers / Social Worker 104100000X
Behavioral Health & Social Service Providers / Clinical 1041C0700X 6801094835 Michigan

Profile Details

NPI number 1528380623
LBN Legal business name Tillery, Ricardo David
Credentials MBA, LMSW, ICAADC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 17th, 2010
Last updated Sep 13th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528380623 NPPES
Michigan MEDICAID 1396128088

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