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Individual
MARITA TILLER
Active
Individual
MARITA TILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C3380
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000WDBCH
GROUP MEDICARE
OR
05
—
164936
—
OR
Enumeration date
03/09/2010
Last updated
06/19/2025
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