Provider Demographics
NPI:1649928292
Name:TILTON, MCKAY L (MA, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:MCKAY
Middle Name:L
Last Name:TILTON
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-4806
Mailing Address - Country:US
Mailing Address - Phone:715-554-7207
Mailing Address - Fax:
Practice Address - Street 1:1241 112TH AVE
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-4806
Practice Address - Country:US
Practice Address - Phone:715-554-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2376101YP2500X
MN304725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)