Provider Demographics
NPI:1568008530
Name:CUSTER, YANG CHANG (MS, MPHIL, LPC)
Entity Type:Individual
Prefix:
First Name:YANG
Middle Name:CHANG
Last Name:CUSTER
Suffix:
Gender:F
Credentials:MS, MPHIL, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 WALNUT ST STE 2323
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4723
Mailing Address - Country:US
Mailing Address - Phone:215-821-4482
Mailing Address - Fax:
Practice Address - Street 1:1845 WALNUT ST STE 2323
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4723
Practice Address - Country:US
Practice Address - Phone:215-821-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional