Provider Demographics
NPI:1881071256
Name:YU, FANGZHOU (PHD)
Entity type:Individual
Prefix:
First Name:FANGZHOU
Middle Name:
Last Name:YU
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 1:111 HARVEY CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4557
Mailing Address - Country:US
Mailing Address - Phone:601-919-7558
Mailing Address - Fax:
Practice Address - Street 1:2906 N STATE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4233
Practice Address - Country:US
Practice Address - Phone:769-524-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional