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General NPI Number Information
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NPI Number | 1194161042
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Entity Type | Individual
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Provider Name | DEBORA ANNE TILLETT MFT INTERN
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Gender | Female
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 2621 OSWELL ST
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City | BAKERSFIELD
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State | CA
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Zip | 93306-3172
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Country | US
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Telephone | 661-868-6750
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Fax | 661-868-6752
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Provider Business Mailing Address
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Address Line | PO BOX 1000
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City | BAKERSFIELD
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State | CA
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Zip | 93302-1000
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Country | US
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Telephone | 661-868-6601
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Fax | 661-868-6666
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 71341
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License Number State | CA
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