Individual
VICTOR T TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D HSPP
Contact information
Practice address
403 E MADISON ST, SOUTH BEND, IN 46617-2322
(574) 283-1234
(574) 537-2652
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041088A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200200740A
—
IN
Enumeration date
03/02/2006
Last updated
10/14/2010
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