Provider Demographics
NPI:1720470081
Name:CHUNG, MINKYUNG (LMHC 13929)
Entity Type:Individual
Prefix:
First Name:MINKYUNG
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LMHC 13929
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S RANGER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4343
Mailing Address - Country:US
Mailing Address - Phone:407-801-9537
Mailing Address - Fax:
Practice Address - Street 1:3001 ALOMA AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3752
Practice Address - Country:US
Practice Address - Phone:407-801-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC 13929101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health