Healthcare Provider Details

I. General information

NPI: 1962571562
Provider Name (Legal Business Name): LIEU 'MICHELLE' NGUYEN VUONG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MCDERMOTT DR SUITE 109
ALLEN TX
75013-2751
US

IV. Provider business mailing address

3210 S COUNTRY CLUB RD
GARLAND TX
75043-1312
US

V. Phone/Fax

Practice location:
  • Phone: 214-641-6390
  • Fax: 214-614-5151
Mailing address:
  • Phone: 214-641-6390
  • Fax: 214-614-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32981
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32981
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: