Provider Demographics
NPI:1194287839
Name:EWING, TANJI (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:TANJI
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3415
Mailing Address - Country:US
Mailing Address - Phone:714-978-6682
Mailing Address - Fax:
Practice Address - Street 1:400 W CIVIC CENTER DR FL 4
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4539
Practice Address - Country:US
Practice Address - Phone:714-796-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111870106H00000X
CA136595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist