MEDICARE: MR. IRWIN A. TANG LPC, MA, MFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	62771	TX

General Provider Information

NPI Number	:	1558669382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IRWIN A. TANG LPC, MA, MFA

Provider Business Mailing Address
First Line	:	12111 FORSYTHE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-3115
Country	:	US
Telephone Number	:	512-832-9039
Fax Number	:

Provider Business Practice Location Address
First Line	:	12701 RESEARCH BLVD STE 311
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4325
Country	:	US
Telephone Number	:	512-554-5431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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