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1316467798
CHARLES L TILLEY
SHREVEPORT, LA
NPI
1316467798
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2017-06-26
Last Update Date
2017-06-26
Business Address
CHARLES L TILLEY
4642 BETHUME DR
SHREVEPORT, LA 71109-6634
Phone number: 318-532-2204
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Mailing Address
CHARLES L TILLEY
700 PIERRE AVE STE A
SHREVEPORT, LA 71103-2725
Phone number: 318-532-9214
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