=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861295156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICK NGO PSYCHOTHERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2025
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4701 PATRICK HENRY DRIVE BUILDING 25 SUITE 125
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-1889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-271-9938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4701 PATRICK HENRY DRIVE BUILDING 25 SUITE 125
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-1889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-271-9938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PATRICK NGO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 650-271-9938
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------