Provider Demographics
NPI:1295518629
Name:LU, CHANG (LMHCA)
Entity type:Individual
Prefix:
First Name:CHANG
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:CORAL
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHCA
Mailing Address - Street 1:330 3RD AVE W UNIT 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4181
Mailing Address - Country:US
Mailing Address - Phone:858-405-3874
Mailing Address - Fax:
Practice Address - Street 1:1817 QUEEN ANNE AVE N STE 402
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2876
Practice Address - Country:US
Practice Address - Phone:858-405-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61446806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health