Individual
GUY F TILLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25 W MAIN ST, CONWAY, NH 03818-6142
(603) 447-2111
Mailing address
87 WASHINGTON ST, CONWAY, NH 03818-6044
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
508
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7706638Y0NH01
ANTHEM
—
Enumeration date
03/31/2007
Last updated
07/08/2007
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