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General NPI Number Information
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NPI Number | 1962161224
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Entity Type | Individual
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Provider Name | TILY CHAO
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Gender | Female
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 1111 W TOKAY ST
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City | LODI
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State | CA
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Zip | 95240-3850
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Country | US
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Telephone | 165-038-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 1149 BUTTE CT
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City | LIVERMORE
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State | CA
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Zip | 94551-1641
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Country | US
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Telephone | 925-758-3610
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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