Provider Demographics
NPI:1184208894
Name:LU, HUAN-TANG (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:HUAN-TANG
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E HIGH ST STE E
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2592
Mailing Address - Country:US
Mailing Address - Phone:856-818-3985
Mailing Address - Fax:
Practice Address - Street 1:1660 SOLDIERS FIELD RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1108
Practice Address - Country:US
Practice Address - Phone:856-818-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00678300101YP2500X
NJ26NR24654600163W00000X
MALMHC10001034101YM0800X
DEPC-0011237101YP2500X
PAPC016597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse