Individual
MICHAEL BENNETT TILDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CTRS, AMGA-SPI
Contact information
Practice address
1490 GREGORY LN # 4, JACKSON, WY 83001-9021
(307) 734-6040
Mailing address
1490 GREGORY LN # 4, JACKSON, WY 83001-9021
(307) 734-6040
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-40146
ID
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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