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General NPI Number Information
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NPI Number | 1396179552
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Entity Type | Individual
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Provider Name | MING LOONG TEO LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 639 N BROADWAY APT 309
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City | LOS ANGELES
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State | CA
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Zip | 90012-4507
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Country | US
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Telephone | 213-245-1085
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 86545
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City | LOS ANGELES
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State | CA
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Zip | 90086-0545
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Country | US
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Telephone | 424-245-9821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 76193
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License Number State | CA
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