Provider Demographics
NPI:1396821559
Name:LEONG, VIVIEN W (PH D)
Entity Type:Individual
Prefix:DR
First Name:VIVIEN
Middle Name:W
Last Name:LEONG
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 1036
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1802
Mailing Address - Country:US
Mailing Address - Phone:713-776-2400
Mailing Address - Fax:713-776-2145
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE 1036
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-776-2400
Practice Address - Fax:713-776-2145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23554103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86902AOtherBLUE CROSS/BLUE SHIELD #
TX86902AOtherBLUE CROSS/BLUE SHIELD #