Provider Demographics
NPI:1831296722
Name:TILTON, BEN K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:K
Last Name:TILTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16052 BEACH BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3801
Mailing Address - Country:US
Mailing Address - Phone:714-717-5415
Mailing Address - Fax:714-841-7474
Practice Address - Street 1:16052 BEACH BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3801
Practice Address - Country:US
Practice Address - Phone:714-717-5415
Practice Address - Fax:714-841-7474
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19609103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist