Provider Demographics
NPI:1841575826
Name:CHANG, MANDY WAH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:WAH
Last Name:CHANG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 THREE RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5309
Mailing Address - Country:US
Mailing Address - Phone:832-282-1251
Mailing Address - Fax:281-242-7723
Practice Address - Street 1:10190 KATY FWY
Practice Address - Street 2:SUITE 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5236
Practice Address - Country:US
Practice Address - Phone:713-647-0002
Practice Address - Fax:713-647-0885
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional