Provider Demographics
NPI:1396098018
Name:TANG, GRACE (LMFT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:WANI
Other - Middle Name:GRACE
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 2323
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-0323
Mailing Address - Country:US
Mailing Address - Phone:408-912-2808
Mailing Address - Fax:
Practice Address - Street 1:1925 WINCHESTER BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1000
Practice Address - Country:US
Practice Address - Phone:408-912-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT520280OtherBLUE SHIELD OF CALIFORNIA