MEDICARE: LEI PHYU TUN 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	101YM0800X	Mental Health Counselor	APC008347	GA

General Provider Information

NPI Number	:	1962108647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEI PHYU TUN LPC

Provider Business Mailing Address
First Line	:	4720 PEACHTREE INDUSTRIAL BLVD STE 4202
Second Line	:
City	:	BERKELEY LAKE
State	:	GA
Zip	:	30071-5738
Country	:	US
Telephone Number	:	470-384-9443
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 PEACHTREE INDUSTRIAL BLVD STE 4202
Second Line	:
City	:	BERKELEY LAKE
State	:	GA
Zip	:	30071-5738
Country	:	US
Telephone Number	:	470-384-9443
Fax Number	:

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

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	08/28/2024

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