Provider Demographics
NPI:1568054120
Name:TANGVALD, ODIN (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ODIN
Middle Name:
Last Name:TANGVALD
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 DURHAM AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2546
Mailing Address - Country:US
Mailing Address - Phone:908-548-8533
Mailing Address - Fax:908-548-8532
Practice Address - Street 1:285 DURHAM AVE STE 2A
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2546
Practice Address - Country:US
Practice Address - Phone:908-548-8533
Practice Address - Fax:908-548-8532
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00832200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty