Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 0013717 | CO |
NPI | 1003342361 |
---|---|
Provider Name | Melissa Tilleman |
First Address | Lakewood, CO 80227-4709 |
Second Address | Lakewood, CO 80227-4709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2017 |
Last Update Date | 05/05/2017 |