Provider Demographics
NPI:1144932989
Name:LE, PHI-LONG (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:PHI-LONG
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 GARDENDALE ST STE C206
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3174
Mailing Address - Country:US
Mailing Address - Phone:210-580-4149
Mailing Address - Fax:
Practice Address - Street 1:4203 GARDENDALE ST STE C206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3174
Practice Address - Country:US
Practice Address - Phone:210-580-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health