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General NPI Number Information
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NPI Number | 1639441850
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Entity Type | Individual
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Provider Name | JACK TSAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 09/29/2018
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Provider Practice Location Address
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Address Line | 8701 SHOAL CREEK BLVD STE 404
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City | AUSTIN
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State | TX
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Zip | 78757-6809
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Country | US
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Telephone | 512-879-1836
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Fax |
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Provider Business Mailing Address
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Address Line | 4708 BULL CREEK RD
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City | AUSTIN
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State | TX
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Zip | 78731-5506
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 35206
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35206
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License Number State | TX
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