Provider Demographics
NPI:1538683883
Name:TIEU, ROMCHOUNG K (PARENT PARTNER)
Entity Type:Individual
Prefix:
First Name:ROMCHOUNG
Middle Name:K
Last Name:TIEU
Suffix:
Gender:F
Credentials:PARENT PARTNER
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:TIEU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PARENT PARTNER
Mailing Address - Street 1:4990 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7409
Mailing Address - Country:US
Mailing Address - Phone:619-668-4263
Mailing Address - Fax:
Practice Address - Street 1:4990 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7409
Practice Address - Country:US
Practice Address - Phone:619-668-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health