MEDICARE: SHILOH MENTAL HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1497698526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHILOH MENTAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	3210 N CANYON RD STE 204
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-5608
Country	:	US
Telephone Number	:	385-204-6273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 N CANYON RD STE 204
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-5608
Country	:	US
Telephone Number	:	385-204-6273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANNER MOFFAT
Credential	:	LCSW
Telephone Number	:	385-204-6273

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “SHILOH MENTAL HEALTH PLLC ” Practice Location

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