Provider Demographics
NPI:1003610478
Name:TANJANG, CRESCENTIA
Entity type:Individual
Prefix:
First Name:CRESCENTIA
Middle Name:
Last Name:TANJANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13217 RIDINGS DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3612
Mailing Address - Country:US
Mailing Address - Phone:240-304-0938
Mailing Address - Fax:
Practice Address - Street 1:4491 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2011
Practice Address - Country:US
Practice Address - Phone:469-697-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician