Provider Demographics
NPI:1386258788
Name:VANG, BAO (MS, PPS, LPCC)
Entity type:Individual
Prefix:
First Name:BAO
Middle Name:
Last Name:VANG
Suffix:
Gender:
Credentials:MS, PPS, LPCC
Other - Prefix:
Other - First Name:BELLE
Other - Middle Name:
Other - Last Name:VANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:150 THE PROMENADE N UNIT 401
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4754
Mailing Address - Country:US
Mailing Address - Phone:510-588-6987
Mailing Address - Fax:
Practice Address - Street 1:1382 BLUE OAKS BLVD STE 213
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-7052
Practice Address - Country:US
Practice Address - Phone:916-209-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC18762101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health