Provider Demographics
NPI:1457834764
Name:HAUSLER-TUNGATE, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:HAUSLER-TUNGATE
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 1:1906 W GARVEY AVE S
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2652
Mailing Address - Country:US
Mailing Address - Phone:310-714-2795
Mailing Address - Fax:
Practice Address - Street 1:1906 W GARVEY AVE S
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2652
Practice Address - Country:US
Practice Address - Phone:310-714-2795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1126161041C0700X, 104100000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner