Provider Demographics
NPI:1386254837
Name:LE NGU, LICENSED PSYCHOLOGIST
Entity type:Organization
Organization Name:LE NGU, LICENSED PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-842-9255
Mailing Address - Street 1:7419 S CREEKVIEW CV
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4769
Mailing Address - Country:US
Mailing Address - Phone:801-875-2128
Mailing Address - Fax:
Practice Address - Street 1:5801 S FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6159
Practice Address - Country:US
Practice Address - Phone:801-875-2128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty