Provider Demographics
NPI:1265510721
Name:YANG, PHOUA (MA)
Entity Type:Individual
Prefix:
First Name:PHOUA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:PHOUA
Other - Middle Name:YANG
Other - Last Name:VANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1821 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE N385
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2801
Mailing Address - Country:US
Mailing Address - Phone:651-644-8515
Mailing Address - Fax:651-644-3451
Practice Address - Street 1:1821 UNIVERSITY AVE W
Practice Address - Street 2:SUITE N385
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:651-644-8515
Practice Address - Fax:651-644-3451
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health