Provider Demographics
NPI:1538578646
Name:VAN DAM, TANJA (LPC)
Entity type:Individual
Prefix:MS
First Name:TANJA
Middle Name:
Last Name:VAN DAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 LILLIAN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5544
Mailing Address - Country:US
Mailing Address - Phone:713-861-4849
Mailing Address - Fax:713-861-4021
Practice Address - Street 1:719 SAWDUST RD
Practice Address - Street 2:SUITE 309
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2910
Practice Address - Country:US
Practice Address - Phone:713-861-4849
Practice Address - Fax:713-861-4021
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional