Provider Demographics
NPI:1831169341
Name:NGUON-LE, PHUONG (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:
Last Name:NGUON-LE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PHUONG
Other - Middle Name:LE
Other - Last Name:NGUON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4834 TAYLORS HILL DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4729
Mailing Address - Country:US
Mailing Address - Phone:801-262-2895
Mailing Address - Fax:
Practice Address - Street 1:3944 S 400 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1600
Practice Address - Country:US
Practice Address - Phone:801-261-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5158951-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical