Provider Demographics
NPI: | 1700309358 |
---|---|
Name: | SHIH, TAMMY HAUYI |
Entity Type: | Individual |
Prefix: | |
First Name: | TAMMY |
Middle Name: | HAUYI |
Last Name: | SHIH |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 205 PASADENA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SOUTH PASADENA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91030-2919 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 323-344-5536 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 205 PASADENA AVE |
Practice Address - Street 2: | |
Practice Address - City: | SOUTH PASADENA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91030-2919 |
Practice Address - Country: | US |
Practice Address - Phone: | 323-344-5536 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2017-07-25 |
Last Update Date: | 2021-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | IMF95584 | 101YM0800X |
CA | 124092 | 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 7184 | Other | MEDI-CAL |
CA | 7368 | Other | MEDI-CAL |
CA | 7667 | Other | MEDI-CAL |
CA | 7708 | Other | MEDI-CAL |