Individual
MATTHEW DANIEL TILLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
15063 CLAYTON RD, CHESTERFIELD, MO 63017-7045
(636) 394-7015
Mailing address
2603 CIRCLE DR, MAPLEWOOD, MO 63143-1706
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2019040725
MO
101YP2500X
Professional Counselor
Primary
2019040725
MO
Other
Enumeration date
08/03/2020
Last updated
03/08/2023
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