Provider Demographics
NPI:1063005916
Name:TENGEN, EDITH LIBUH
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:LIBUH
Last Name:TENGEN
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 1:6323 GEORGIA AVE NW STE 350
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1151
Mailing Address - Country:US
Mailing Address - Phone:202-878-6993
Mailing Address - Fax:202-878-6978
Practice Address - Street 1:6323 GEORGIA AVE NW STE 350
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1151
Practice Address - Country:US
Practice Address - Phone:202-878-6993
Practice Address - Fax:202-878-6978
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health