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Organization
SOUTHERN CALIFORNIA PSYCHOLOGICAL
Active
Organization
SOUTHERN CALIFORNIA PSYCHOLOGICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERELY TILLEY (PRESIDENT)
(714) 505-2093
Entity
Organization
Contact information
Practice address
17821 17TH ST STE 250, TUSTIN, CA 92780-2173
(714) 505-2093
(714) 573-0072
Mailing address
17821 17TH ST STE 250, TUSTIN, CA 92780-2173
(714) 505-2093
(714) 573-0072
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PSY23488
CA
Other
Enumeration date
08/21/2013
Last updated
08/21/2013
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