M'LISA TILLACK

AMERICAN FORK, UT
NPI1134377211
Former NameM'LISA JACKSON
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: UT  13275)
Enumeration Date2008-09-03
Last Update Date2019-04-09
Business Address
M'LISA TILLACK LCSW
131 S 700 E STE 102
AMERICAN FORK, UT 84003
Phone number: 801-701-8061
Mailing Address
M'LISA TILLACK LCSW
1780 W 500 S
SALT LAKE CITY, UT 84104-3505
Phone number: 801-725-4140
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