Healthcare Provider Details

I. General information

NPI: 1134056674
Provider Name (Legal Business Name): LAWRENCE ALBERT CHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 CHURN CREEK RD STE A
REDDING CA
96002-1117
US

IV. Provider business mailing address

1135 COLORADO CT
REDDING CA
96003-8656
US

V. Phone/Fax

Practice location:
  • Phone: 530-221-7474
  • Fax:
Mailing address:
  • Phone: 530-221-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: