Provider Demographics
NPI:1700963873
Name:TILUS, MICHAEL RAY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:TILUS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1802
Mailing Address - Country:US
Mailing Address - Phone:406-867-4105
Mailing Address - Fax:406-867-4102
Practice Address - Street 1:10 4TH ST W
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1802
Practice Address - Country:US
Practice Address - Phone:406-867-4105
Practice Address - Fax:406-867-4102
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6975101YP1600X
MT30490101YP2500X
CA40700106H00000X
MT2585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81350023Medicaid
AZ8HF107Medicare ID - Type UnspecifiedMEDICARE FT. DEFIANCE
AZ052862Medicare UPIN
NM81350023Medicaid