Provider Demographics
NPI:1598541823
Name:MIGUM GWEON LMFT, PLLC
Entity Type:Organization
Organization Name:MIGUM GWEON LMFT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIGUM
Authorized Official - Middle Name:
Authorized Official - Last Name:GWEON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-344-2105
Mailing Address - Street 1:732 FAST GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:626-344-2105
Mailing Address - Fax:
Practice Address - Street 1:10409 PACIFIC PALISADES AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:626-344-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty