Healthcare Provider Details

I. General information

NPI: 1386254837
Provider Name (Legal Business Name): LE NGU, LICENSED PSYCHOLOGIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S FASHION BLVD
MURRAY UT
84107-6159
US

IV. Provider business mailing address

7419 S CREEKVIEW CV
COTTONWOOD HEIGHTS UT
84121-4769
US

V. Phone/Fax

Practice location:
  • Phone: 801-875-2128
  • Fax:
Mailing address:
  • Phone: 801-875-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. LE NGU
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 801-842-9255