MEDICARE: RAELARA TILDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT109187	CA
2	106H00000X	Marriage & Family Therapist	877	HI
3	106H00000X	Marriage & Family Therapist		NV

General Provider Information

NPI Number	:	1972882728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAELARA TILDEN

Provider Business Mailing Address
First Line	:	3960 E PATRICK LN STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4902
Country	:	US
Telephone Number	:	702-955-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 E PATRICK LN STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4902
Country	:	US
Telephone Number	:	702-955-1120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	06/14/2024

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Directions to “ RAELARA TILDEN ” Practice Location

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