Provider Demographics
NPI:1699368266
Name:TILBERG, MICHELLE LEE (MA, PLPC 2021005293)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:TILBERG
Suffix:
Gender:F
Credentials:MA, PLPC 2021005293
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39695 HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-8923
Mailing Address - Country:US
Mailing Address - Phone:573-337-3180
Mailing Address - Fax:
Practice Address - Street 1:13160 COUNTY ROAD 3610
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-9151
Practice Address - Country:US
Practice Address - Phone:573-899-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021005293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health