Provider Demographics
NPI:1467675793
Name:THOEURB, TEP
Entity Type:Individual
Prefix:
First Name:TEP
Middle Name:
Last Name:THOEURB
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 1:1524 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2303
Mailing Address - Country:US
Mailing Address - Phone:562-896-5627
Mailing Address - Fax:
Practice Address - Street 1:1524 E 15TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2303
Practice Address - Country:US
Practice Address - Phone:562-896-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical