Provider Demographics
NPI:1033614037
Name:BRIAN GONG PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:BRIAN GONG PSYCHOTHERAPY, LLC
Other - Org Name:BRIAN GONG PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYCOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-501-1008
Mailing Address - Street 1:401 LINTON BLVD
Mailing Address - Street 2:SUITE 200-A
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444
Mailing Address - Country:US
Mailing Address - Phone:561-501-1008
Mailing Address - Fax:561-431-2608
Practice Address - Street 1:401 LINTON BLVD
Practice Address - Street 2:SUITE 200-A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444
Practice Address - Country:US
Practice Address - Phone:561-501-1008
Practice Address - Fax:561-431-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty