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Individual

M'LISA TILLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
131 S 700 E STE 102, AMERICAN FORK, UT 84003
(801) 701-8061
Mailing address
1780 W 500 S, SALT LAKE CITY, UT 84104-3505
(801) 725-4140

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13275
UT

Other

Enumeration date
09/03/2008
Last updated
04/09/2019
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