Healthcare Provider Details

I. General information

NPI: 1073627477
Provider Name (Legal Business Name): GABRIEL TAN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 KATY FREEWAY, STE 200
HOUSTON TX
77024
US

IV. Provider business mailing address

1259 MISTY LAKE COURT
SUGAR LAND TX
77498-5613
US

V. Phone/Fax

Practice location:
  • Phone: 346-702-8936
  • Fax: 713-794-7674
Mailing address:
  • Phone: 346-702-8936
  • Fax: 713-794-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number24013
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: