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General NPI Number Information
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NPI Number | 1871788976
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Entity Type | Individual
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Provider Name | DR. CANDICE TILL
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Gender | Female
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 3155 OLD CONEJO RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2151
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Country | US
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Telephone | 562-754-2310
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Fax |
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Provider Business Mailing Address
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Address Line | 3155 OLD CONEJO RD
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City | NEWBURY PARK
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State | CA
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Zip | 91320-2151
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Country | US
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Telephone | 714-310-4493
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 29106
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License Number State | CA
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