| Doctor Tlc, License Clinical Psychologist, Inc. | |
|
1242 Third St Promenade, Suite 208 Santa Monica CA 90401 | |
| (201) 406-9496 | |
| Not Available |
| Full Name | Doctor Tlc, License Clinical Psychologist, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1242 Third St Promenade,, Santa Monica, California |
| Authorized Official Name and Position | Teresa Liaw Chung (CEO) |
| Authorized Official Contact | 4242725233 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Doctor Tlc, License Clinical Psychologist, Inc. 1242 Third St Promenade, Suite 208 Santa Monica CA 90401 Ph: (201) 406-9496 | Doctor Tlc, License Clinical Psychologist, Inc. 1242 Third St Promenade, Suite 208 Santa Monica CA 90401 Ph: (201) 406-9496 |
| NPI Number | 1528507084 |
|---|---|
| Provider Enumeration Date | 02/16/2017 |
| Last Update Date | 07/17/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528507084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | PSY27669 (California) | Primary |
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