Basic Information
| Provider Information | |||||||||
| NPI: | 1982169827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAN | ||||||||
| FirstName: | STELLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515305900 | ||||||||
| FaxNumber: | 9515305945 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515305900 | ||||||||
| FaxNumber: | 9515305945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2019 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | ASW100804 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | ASW100804 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.