Healthcare Provider Details

I. General information

NPI: 1851037931
Provider Name (Legal Business Name): CHING YI KUO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 01/02/2024
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17350 STATE HIGHWAY 249 STE 220
HOUSTON TX
77064-1132
US

IV. Provider business mailing address

3206 JOHNSON RD
SOUTHLAKE TX
76092-5614
US

V. Phone/Fax

Practice location:
  • Phone: 940-435-8972
  • Fax:
Mailing address:
  • Phone: 940-435-8972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88644
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: