Provider Demographics
NPI:1396974788
Name:TONG, PHILIP HONG (LICENSED MFT)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:HONG
Last Name:TONG
Suffix:
Gender:M
Credentials:LICENSED MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-0226
Mailing Address - Country:US
Mailing Address - Phone:650-922-7503
Mailing Address - Fax:
Practice Address - Street 1:408 LOMITA AVE
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1118
Practice Address - Country:US
Practice Address - Phone:650-922-7503
Practice Address - Fax:650-922-7503
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67175101YM0800X
225400000X
CA82205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner