Provider Demographics
NPI:1275999690
Name:TAN, TIONG YEE (LCSW)
Entity Type:Individual
Prefix:
First Name:TIONG YEE
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14271 JEFFREY RD # 220
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3405
Mailing Address - Country:US
Mailing Address - Phone:949-648-8305
Mailing Address - Fax:
Practice Address - Street 1:600 ANTON BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7100
Practice Address - Country:US
Practice Address - Phone:949-229-6943
Practice Address - Fax:949-576-3913
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW68567101YM0800X
CA886931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health