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General NPI Number Information
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NPI Number | 1639872294
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Entity Type | Individual
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Provider Name | TIA VANG LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 1527 E LAKE ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-6700
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Country | US
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Telephone | 612-294-2651
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Fax |
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Provider Business Mailing Address
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Address Line | 1139 COUNTY ROAD H2 E
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55127-6708
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Country | US
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Telephone | 651-226-5133
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3877
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License Number State | MN
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