Provider Demographics
NPI:1326458340
Name:CHANG, CHONG (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 WOODDALE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4421
Mailing Address - Country:US
Mailing Address - Phone:651-300-3328
Mailing Address - Fax:651-419-1314
Practice Address - Street 1:2042 WOODDALE DR STE 250
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4421
Practice Address - Country:US
Practice Address - Phone:651-300-3328
Practice Address - Fax:651-419-1314
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN981932200Medicaid