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General NPI Number Information
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NPI Number | 1033614037
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Entity Type | Organization
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Legal Business Name | BRIAN GONG PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 401 LINTON BLVD SUITE 200-A
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City | DELRAY BEACH
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State | FL
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Zip | 33444
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Country | US
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Telephone | 561-501-1008
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Fax | 561-431-2608
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Provider Business Mailing Address
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Address Line | 401 LINTON BLVD SUITE 200-A
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City | DELRAY BEACH
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State | FL
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Zip | 33444
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Country | US
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Telephone | 561-501-1008
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Fax | 561-431-2608
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Authorized Official
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Title or Position | OWNER/PHYCOTHERAPIST
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Name | MR. BRIAN MICHAEL GONG
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Credential | LMHC
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Telephone | 561-501-1008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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