=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639090400
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. TROY ANTHONY LITTLEJOHN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2026
-----------------------------------------------------
Last Update Date | 07/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 LUCERA CT APT 203
-----------------------------------------------------
City | PHILLIPS RANCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91766-6807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-525-3698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 LUCERA CT APT 203
-----------------------------------------------------
City | PHILLIPS RANCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91766-6807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 163549
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------