Healthcare Provider Details

I. General information

NPI: 1306565700
Provider Name (Legal Business Name): NICOLE TIBBITS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18350 MOUNT LANGLEY ST STE 220
FOUNTAIN VALLEY CA
92708-6912
US

IV. Provider business mailing address

18350 MOUNT LANGLEY ST STE 220
FOUNTAIN VALLEY CA
92708-6912
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-2620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY005950
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: