Provider Demographics
NPI:1578018289
Name:TILLAPAUGH, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:TILLAPAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 W ORION AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7081
Mailing Address - Country:US
Mailing Address - Phone:310-874-2842
Mailing Address - Fax:
Practice Address - Street 1:711 E BALL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5930
Practice Address - Country:US
Practice Address - Phone:714-252-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health