Healthcare Provider Details

I. General information

NPI: 1902718570
Provider Name (Legal Business Name): TY'JALAYAH ROBERTSON MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 BREA BLVD STE 245
FULLERTON CA
92835-4173
US

IV. Provider business mailing address

PO BOX 1015
CHINO HILLS CA
91709-0034
US

V. Phone/Fax

Practice location:
  • Phone: 714-451-0791
  • Fax:
Mailing address:
  • Phone: 909-536-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: