| Doctor Name: | JAY EL TILLMAN |
| NPI Number: | 1154501047 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | RS2684 |
| Business Practice Address: | 6885 Old Hwy 53 Clearlake, CA - 95422 |
| Business Phone Number: | 7079953235 |
| Business Fax Number: | |
| Mailing Address: | 6840 S Center Dr, CLEARLAKE |
| State: | CA |
| Postal Code: | 954228134 |
| Phone Number: | 7079951232 |
| Fax Number: | |
| NPI Enumeration Date: | 11/07/2007 |
| NPI Last Update Date: | 11/07/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | RS2684 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |