Provider Demographics
NPI:1083098990
Name:TILMON, MARLON (BCBA)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:TILMON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 W CRESCENT AVE
Mailing Address - Street 2:244
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3809
Mailing Address - Country:US
Mailing Address - Phone:818-577-8743
Mailing Address - Fax:
Practice Address - Street 1:2115 W CRESCENT AVE
Practice Address - Street 2:244
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3809
Practice Address - Country:US
Practice Address - Phone:818-577-8743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-10254103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst