Provider Demographics
NPI:1659985240
Name:MENG CHANG LICENSED MARRIAGE AND FAMILY THERAPIST
Entity Type:Organization
Organization Name:MENG CHANG LICENSED MARRIAGE AND FAMILY THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MENG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:408-916-3463
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 1:1174 LINCOLN AVE STE 8
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3029
Practice Address - Country:US
Practice Address - Phone:408-916-3463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty