MEDICARE: DR. CANDICE TILL

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	101Y00000X	Counselor
2	103TC0700X	Clinical Psychologist	29106	CA

General Provider Information

NPI Number	:	1871788976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDICE TILL

Provider Business Mailing Address
First Line	:	3155 OLD CONEJO RD
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-2151
Country	:	US
Telephone Number	:	714-310-4493
Fax Number	:

Provider Business Practice Location Address
First Line	:	3155 OLD CONEJO RD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91320-2151
Country	:	US
Telephone Number	:	562-754-2310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	11/14/2025

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