Healthcare Provider Details

I. General information

NPI: 1477294452
Provider Name (Legal Business Name): NAMU COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BEDFORD ST STE 25
LEXINGTON MA
02420-4641
US

IV. Provider business mailing address

76 BEDFORD ST STE 25
LEXINGTON MA
02420-4641
US

V. Phone/Fax

Practice location:
  • Phone: 617-383-4176
  • Fax:
Mailing address:
  • Phone: 617-383-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. YOO-YUN CHO-CHANG
Title or Position: OWNER/MANAGER
Credential: PSYCHOLOGIST
Phone: 603-491-9403