Provider Demographics
NPI:1174730469
Name:RHODES, PANG FOUA YANG (LMFT)
Entity type:Individual
Prefix:MS
First Name:PANG FOUA
Middle Name:YANG
Last Name:RHODES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S CREEK DR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-1548
Mailing Address - Country:US
Mailing Address - Phone:651-308-5832
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR LIFE TRANSFORMATION
Practice Address - Street 2:1200 N 69TH AVE
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1548
Practice Address - Country:US
Practice Address - Phone:651-308-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1427OtherLMFT LICENSE NUMBER