Jillian Leigh Tague, MA, ED.S

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4437 Issued in CA

Practice address

8882 Bellshire Dr
Huntington Beach, CA 92646-4615

Phone

(714) 330-8277

NPI assigned

Dec 7, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jillian Leigh Malczynski Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1701907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1447027628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8882 BELLSHIRE DR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926464615",
            "telephone_number": "714-330-8277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8882 BELLSHIRE DR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926464615",
            "telephone_number": "714-330-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAGUE",
        "first_name": "JILLIAN",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "MA, ED.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-12-07",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "4437",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CA",
            "license": "4437",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "MALCZYNSKI",
            "middle_name": "LEIGH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Tamlyn S Lee DDS Inc (Huntington Family Dentistry)

• Psychologist in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.