Provider Demographics
NPI:1861099988
Name:SOSOO, TATYANA
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:SOSOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 S GREEN DR APT 1501
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4578
Mailing Address - Country:US
Mailing Address - Phone:713-413-7864
Mailing Address - Fax:
Practice Address - Street 1:1799 KIRBY DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5607
Practice Address - Country:US
Practice Address - Phone:281-407-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician