Healthcare Provider Details

I. General information

NPI: 1891037479
Provider Name (Legal Business Name): RACHEL L TILLMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

IV. Provider business mailing address

3223 GREYLING DR UNIT 231335
SAN DIEGO CA
92193-7071
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-6469
  • Fax:
Mailing address:
  • Phone: 619-736-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: