Provider Demographics
NPI:1245456797
Name:NGU, LE Q (PHD)
Entity type:Individual
Prefix:DR
First Name:LE
Middle Name:Q
Last Name:NGU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7419 S CREEKVIEW CV
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4769
Mailing Address - Country:US
Mailing Address - Phone:801-842-9255
Mailing Address - Fax:
Practice Address - Street 1:5801 S FASHION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6162
Practice Address - Country:US
Practice Address - Phone:801-875-2128
Practice Address - Fax:855-373-2007
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70577322501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000074083OtherPTAN
UTU000074083Medicare UPIN