Provider Demographics
NPI:1013761188
Name:YANG, PHAKOUEW YACHAI (BA)
Entity Type:Individual
Prefix:
First Name:PHAKOUEW
Middle Name:YACHAI
Last Name:YANG
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:VSHIN
Other - Middle Name:YACHAI
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:1150 HENNEPIN AVE APT 2003
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1720
Mailing Address - Country:US
Mailing Address - Phone:763-438-9502
Mailing Address - Fax:
Practice Address - Street 1:1833 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2424
Practice Address - Country:US
Practice Address - Phone:612-924-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health