Provider Demographics
NPI:1972882728
Name:TILDEN, RAELARA
Entity type:Individual
Prefix:
First Name:RAELARA
Middle Name:
Last Name:TILDEN
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 1:3960 E PATRICK LN STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4902
Mailing Address - Country:US
Mailing Address - Phone:702-955-1120
Mailing Address - Fax:
Practice Address - Street 1:3960 E PATRICK LN STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4902
Practice Address - Country:US
Practice Address - Phone:702-955-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT109187106H00000X
HI877106H00000X
NV106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty