Organization
ALTA-GRACE L TAN, PSY D PSYCHOLOGICAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALTA-GRACE L TAN PSY D (OWNER)
(818) 523-1809
Entity
Organization
Contact information
Practice address
18546 ROSCOE BLVD, STE 210, NORTHRIDGE, CA 91324-5454
(818) 886-5628
Mailing address
18546 ROSCOE BLVD STE 210, NORTHRIDGE, CA 91324-5454
(818) 886-5628
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY18653
CA
Other
Enumeration date
09/11/2006
Last updated
05/28/2010
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