Provider Demographics
NPI:1245665447
Name:LE, PHUONG KHANH QUY (LCSW)
Entity type:Individual
Prefix:
First Name:PHUONG KHANH
Middle Name:QUY
Last Name:LE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8197 LIME CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3365
Mailing Address - Country:US
Mailing Address - Phone:714-230-9110
Mailing Address - Fax:
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-967-0211
Practice Address - Fax:562-346-3594
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 225400000X
CA804941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner