Alta-Grace L Tan, Psy D Psychological Services, Inc

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY18653 Issued in CA

Legal business name

ALTA-GRACE L TAN, PSY D PSYCHOLOGICAL SERVICES, INC

Practice address

18546 Roscoe Blvd
Ste 210
Northridge, CA 91324-5454

Phone

(818) 886-5628

NPI assigned

Sep 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alta-Grace L Tan, PSY D

Title

Owner

Phone

(818) 523-1809

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275004800000",
    "number": "1104920230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18546 ROSCOE BLVD STE 210",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245454",
            "telephone_number": "818-886-5628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18546 ROSCOE BLVD",
            "address_2": "STE 210",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245454",
            "telephone_number": "818-886-5628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA-GRACE L TAN, PSY D PSYCHOLOGICAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2010-05-28",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "ALTA-GRACE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-523-1809",
        "authorized_official_credential": "PSY D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY18653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Northridge, CA
• Providers in Northridge, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.