Provider Demographics
NPI: | 1265037907 |
---|---|
Name: | SHUEH, TONG-AN (PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | TONG-AN |
Middle Name: | |
Last Name: | SHUEH |
Suffix: | |
Gender: | M |
Credentials: | PHD |
Other - Prefix: | DR |
Other - First Name: | FRED |
Other - Middle Name: | |
Other - Last Name: | SHUEH |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | PHD |
Mailing Address - Street 1: | 9008 TRAILRIDGE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SANTEE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92071-2048 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 352-577-5277 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 9008 TRAILRIDGE AVE |
Practice Address - Street 2: | |
Practice Address - City: | SANTEE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92071-2048 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-577-5277 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2020-12-01 |
Last Update Date: | 2023-08-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 32950 | 103TP2701X, 103TC1900X, 103T00000X |
OH | P.7398 | 103TP2701X, 103T00000X, 103TC1900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |