Provider Demographics
NPI:1932795499
Name:XIONG, PAHOUA (LPC)
Entity Type:Individual
Prefix:
First Name:PAHOUA
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:WI
Mailing Address - Zip Code:53007-0148
Mailing Address - Country:US
Mailing Address - Phone:141-247-0801
Mailing Address - Fax:141-247-0806
Practice Address - Street 1:6025 N GREEN BAY AVE FL 2
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3811
Practice Address - Country:US
Practice Address - Phone:414-247-0801
Practice Address - Fax:414-247-0816
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4845101YP2500X
WI10489-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4845OtherSTATE OF WISCONSIN