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General NPI Number Information
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NPI Number | 1790409852
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Entity Type | Organization
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Legal Business Name | BELONG PSYCHOTHERAPY INC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 250 W MAIN ST STE 103
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City | TUSTIN
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State | CA
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Zip | 92780-7717
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Country | US
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Telephone | 657-214-4787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5304
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92615-5304
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Country | US
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Telephone | 657-214-4787
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | NINA TILKA
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Credential | PHD
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Telephone | 657-214-4787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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