Provider Demographics
NPI:1619465275
Name:TA, SAN CHIEU (LCSW)
Entity Type:Individual
Prefix:
First Name:SAN
Middle Name:CHIEU
Last Name:TA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 GIANNA CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-8015
Mailing Address - Country:US
Mailing Address - Phone:281-673-7950
Mailing Address - Fax:
Practice Address - Street 1:2500 WILCREST DR
Practice Address - Street 2:STE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2754
Practice Address - Country:US
Practice Address - Phone:281-892-1980
Practice Address - Fax:281-892-1983
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical