Healthcare Provider Details

I. General information

NPI: 1104373851
Provider Name (Legal Business Name): HUEY TYAN CHONG LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HT CHONG LMHC

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PARK ST APT 2
GARDNER MA
01440-1678
US

IV. Provider business mailing address

155 PARK ST APT 2
GARDNER MA
01440-1678
US

V. Phone/Fax

Practice location:
  • Phone: 508-986-9195
  • Fax:
Mailing address:
  • Phone: 508-986-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC12020
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: