Provider Demographics
NPI:1588811681
Name:BERTSCH, TIANNA KYONG (PHD)
Entity type:Individual
Prefix:DR
First Name:TIANNA
Middle Name:KYONG
Last Name:BERTSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 WIN HENTSCHEL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4149
Mailing Address - Country:US
Mailing Address - Phone:765-444-3999
Mailing Address - Fax:
Practice Address - Street 1:1330 WIN HENTSCHEL BLVD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-4149
Practice Address - Country:US
Practice Address - Phone:765-444-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE803103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling