Provider Demographics
NPI:1508348533
Name:TU, DOUGLAS
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:TU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 CENTER COURT DR STE 105
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3681
Mailing Address - Country:US
Mailing Address - Phone:626-790-1801
Mailing Address - Fax:626-380-0730
Practice Address - Street 1:1338 CENTER COURT DR.
Practice Address - Street 2:105
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724
Practice Address - Country:US
Practice Address - Phone:626-790-1801
Practice Address - Fax:626-380-0730
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106379OtherBBS