MEDICARE: IRIS CHU-CHEN CHANG LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	201718	TX
2	101YP2500X	Professional Counselor	68253	TX

General Provider Information

NPI Number	:	1235412149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS CHU-CHEN CHANG LPC

Provider Business Mailing Address
First Line	:	5342 DUMFRIES DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5121
Country	:	US
Telephone Number	:	617-291-7048
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 CORPORATE DR STE 215
Second Line	:	HOUSTON, TX
City	:	HOUSTON
State	:	TX
Zip	:	77036-5140
Country	:	US
Telephone Number	:	617-291-7048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	03/04/2014

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Directions to “ IRIS CHU-CHEN CHANG LPC” Practice Location

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