Southern California Psychological

Primary specialty

SpecialistTaxonomy code 174400000X

License

PSY23488 Issued in CA

Legal business name

SOUTHERN CALIFORNIA PSYCHOLOGICAL

Practice address

17821 17TH St Ste 250
Tustin, CA 92780-2173

Phone

(714) 505-2093

Fax

(714) 573-0072

NPI assigned

Aug 21, 2013

Last updated

Aug 21, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kimberely Tilley

Title

President

Phone

(714) 505-2093

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377043200000",
    "number": "1053745497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17821 17TH ST STE 250",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802173",
            "telephone_number": "714-505-2093",
            "fax_number": "714-573-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17821 17TH ST STE 250",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802173",
            "telephone_number": "714-505-2093",
            "fax_number": "714-573-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PSYCHOLOGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-21",
        "last_updated": "2013-08-21",
        "status": "A",
        "authorized_official_last_name": "TILLEY",
        "authorized_official_first_name": "KIMBERELY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-505-2093",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "PSY23488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Tustin, CA
• Providers in Tustin, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.