Provider Demographics
NPI:1467775973
Name:CHANG, MENG (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MENG
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1174 LINCOLN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3029
Mailing Address - Country:US
Mailing Address - Phone:408-916-3463
Mailing Address - Fax:
Practice Address - Street 1:17901 VON KARMAN AVE STE 600
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5249
Practice Address - Country:US
Practice Address - Phone:408-916-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT#88012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist