Provider Demographics
NPI:1558686584
Name:CHANG, TINA MARIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:CHANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:BIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2130 E 4TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3818
Mailing Address - Country:US
Mailing Address - Phone:714-543-5437
Mailing Address - Fax:714-543-5463
Practice Address - Street 1:2130 E 4TH ST
Practice Address - Street 2:STE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3818
Practice Address - Country:US
Practice Address - Phone:714-543-5437
Practice Address - Fax:714-543-5463
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist