Provider Demographics
NPI:1164631404
Name:WILLIAMS, TYJA LA SHUN
Entity Type:Individual
Prefix:MS
First Name:TYJA
Middle Name:LA SHUN
Last Name:WILLIAMS
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 1:13409 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3323
Mailing Address - Country:US
Mailing Address - Phone:562-570-3295
Mailing Address - Fax:562-570-1266
Practice Address - Street 1:6335 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2430
Practice Address - Country:US
Practice Address - Phone:562-570-3300
Practice Address - Fax:562-570-1266
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor