Provider Demographics
NPI:1154788438
Name:XIONG, PA HOUA THAO (MSE, LPC-IT)
Entity type:Individual
Prefix:
First Name:PA HOUA
Middle Name:THAO
Last Name:XIONG
Suffix:
Gender:F
Credentials:MSE, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3907
Mailing Address - Country:US
Mailing Address - Phone:920-251-8302
Mailing Address - Fax:
Practice Address - Street 1:1478 KENWOOD DR STE 1
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1161
Practice Address - Country:US
Practice Address - Phone:920-886-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional