Provider Demographics
NPI:1942697099
Name:TILBURY, NANCY ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANN
Last Name:TILBURY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3965 W. 83RD ST
Mailing Address - Street 2:#156
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208
Mailing Address - Country:US
Mailing Address - Phone:816-686-6277
Mailing Address - Fax:
Practice Address - Street 1:4700 W. 64TH TERR
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:816-686-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2735101YP2500X
VA0701007394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional