Healthcare Provider Details

I. General information

NPI: 1720470081
Provider Name (Legal Business Name): MINKYUNG CHUNG LMHC 13929
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 E LAS OLAS BLVD # 1704
FT LAUDERDALE FL
33301-2334
US

IV. Provider business mailing address

1314 E LAS OLAS BLVD # 1704
FT LAUDERDALE FL
33301-2334
US

V. Phone/Fax

Practice location:
  • Phone: 407-801-9537
  • Fax:
Mailing address:
  • Phone: 407-801-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC 13929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: