Provider Demographics
NPI:1861747982
Name:POON, LAYHEARB TEP (LCSW)
Entity type:Individual
Prefix:
First Name:LAYHEARB
Middle Name:TEP
Last Name:POON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 E PACIFIC COAST HWY STE 600
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6914
Mailing Address - Country:US
Mailing Address - Phone:562-346-1131
Mailing Address - Fax:
Practice Address - Street 1:4510 E PACIFIC COAST HWY STE 600
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-6914
Practice Address - Country:US
Practice Address - Phone:562-346-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26147104100000X
CALCSW 596081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker