Provider Demographics
NPI:1053031740
Name:TILLMON, KYNDRA TAMIA DENISE
Entity type:Individual
Prefix:
First Name:KYNDRA
Middle Name:TAMIA DENISE
Last Name:TILLMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DOMINION PARK DR APT 527
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-6737
Mailing Address - Country:US
Mailing Address - Phone:832-687-0235
Mailing Address - Fax:
Practice Address - Street 1:14058 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6848
Practice Address - Country:US
Practice Address - Phone:832-687-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician