Provider Demographics
NPI:1376951772
Name:SY, JENNIFER TANG (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TANG
Last Name:SY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5703
Mailing Address - Country:US
Mailing Address - Phone:832-900-1280
Mailing Address - Fax:713-526-3226
Practice Address - Street 1:1401 CASTLE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5703
Practice Address - Country:US
Practice Address - Phone:832-900-1280
Practice Address - Fax:713-526-3226
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical