Healthcare Provider Details

I. General information

NPI: 1396672804
Provider Name (Legal Business Name): TIANYI GUAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 IRVING AVE
BROOKLYN NY
11237-8024
US

IV. Provider business mailing address

2810 JACKSON AVE APT 34E
LONG ISLAND CITY NY
11101-3171
US

V. Phone/Fax

Practice location:
  • Phone: 949-232-6984
  • Fax:
Mailing address:
  • Phone: 949-232-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: