Provider Demographics
NPI:1558669382
Name:TANG, IRWIN A (LPC, MA, MFA)
Entity Type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:A
Last Name:TANG
Suffix:
Gender:M
Credentials:LPC, MA, MFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12111 FORSYTHE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3115
Mailing Address - Country:US
Mailing Address - Phone:512-832-9039
Mailing Address - Fax:
Practice Address - Street 1:12701 RESEARCH BLVD STE 311
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4325
Practice Address - Country:US
Practice Address - Phone:512-554-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional