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General NPI Number Information
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NPI Number | 1457813859
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Entity Type | Individual
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Provider Name | MARK TINLEY LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 1605 HOPE ST STE 300
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City | S PASADENA
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State | CA
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Zip | 91030-2655
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Country | US
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Telephone | 213-228-3511
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Fax |
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Provider Business Mailing Address
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Address Line | 1718 MERIDIAN AVE APT C
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5514
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Country | US
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Telephone | 626-620-6261
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Fax |
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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 | 52487
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License Number State | CA
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