Provider Demographics
NPI:1962571562
Name:VUONG, LIEU 'MICHELLE' NGUYEN (PHD)
Entity type:Individual
Prefix:
First Name:LIEU 'MICHELLE'
Middle Name:NGUYEN
Last Name:VUONG
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 1:3210 S COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1312
Mailing Address - Country:US
Mailing Address - Phone:214-641-6390
Mailing Address - Fax:214-614-5151
Practice Address - Street 1:101 W MCDERMOTT DR
Practice Address - Street 2:SUITE 109
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2751
Practice Address - Country:US
Practice Address - Phone:214-641-6390
Practice Address - Fax:214-614-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32981103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist