Healthcare Provider Details

I. General information

NPI: 1255998498
Provider Name (Legal Business Name): TT PSYCHOLOGICAL & MEDICAL CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E GLENOAKS BLVD STE 230
GLENDALE CA
91207-2127
US

IV. Provider business mailing address

221 E GLENOAKS BLVD STE 230
GLENDALE CA
91207-2127
US

V. Phone/Fax

Practice location:
  • Phone: 626-540-2101
  • Fax:
Mailing address:
  • Phone: 626-540-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANILGA TABIBIAN
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 626-540-2101