Provider Demographics
NPI:1043940505
Name:TIONG YEE TAN LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:TIONG YEE TAN LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIONG YEE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:949-229-6943
Mailing Address - Street 1:5000 BIRCH STREET WEST TOWER
Mailing Address - Street 2:SUITE 3000 ATTENTION: MONTES LCSW
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2140
Mailing Address - Country:US
Mailing Address - Phone:949-229-6943
Mailing Address - Fax:949-576-3913
Practice Address - Street 1:5000 BIRCH STREET WEST TOWER
Practice Address - Street 2:SUITE 3000 ATTENTION: MONTES LCSW
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2140
Practice Address - Country:US
Practice Address - Phone:949-229-6943
Practice Address - Fax:949-576-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical