Basic Information
| Provider Information | |||||||||
| NPI: | 1518595115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZHANG | ||||||||
| FirstName: | TIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2215 E OAK ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720324644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013360511 | ||||||||
| FaxNumber: | 5013364037 | ||||||||
| Practice Location | |||||||||
| Address1: | 2215 E OAK ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720324644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013360511 | ||||||||
| FaxNumber: | 5013364037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2020 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A2003052 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.