Healthcare Provider Details

I. General information

NPI: 1548519796
Provider Name (Legal Business Name): DAVID STEPHEN TAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3932 SERENA AVE
CLOVIS CA
93619-0512
US

IV. Provider business mailing address

3932 SERENA AVE
CLOVIS CA
93619-0512
US

V. Phone/Fax

Practice location:
  • Phone: 559-269-0647
  • Fax:
Mailing address:
  • Phone: 559-269-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT86903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: