Provider Demographics
NPI:1245324664
Name:TILTON, JOHN GREGORY (BA MED LCPC NCC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GREGORY
Last Name:TILTON
Suffix:
Gender:M
Credentials:BA MED LCPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3017 9TH ST NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404
Mailing Address - Country:US
Mailing Address - Phone:406-453-4356
Mailing Address - Fax:406-453-6030
Practice Address - Street 1:3017 9TH ST NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404
Practice Address - Country:US
Practice Address - Phone:406-453-4356
Practice Address - Fax:406-453-6030
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0252705Medicaid