Provider Demographics
NPI:1861826927
Name:TSENG, ANDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:TSENG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LINDH RD APT 50
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3740
Mailing Address - Country:US
Mailing Address - Phone:917-697-0222
Mailing Address - Fax:
Practice Address - Street 1:400 VETERANS AVE (116B)
Practice Address - Street 2:VA GULF COAST HEALTH CARE SYSTEM
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-523-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical