Provider Demographics
NPI:1235515305
Name:TANG, JEFFREY P (LMFT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:TANG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14781 POMERADO RD # 574
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2802
Mailing Address - Country:US
Mailing Address - Phone:626-502-6184
Mailing Address - Fax:
Practice Address - Street 1:8775 AERO DR STE 240
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1756
Practice Address - Country:US
Practice Address - Phone:619-304-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF# 77622106H00000X
CALMFT96993106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist