Provider Demographics
NPI:1851137079
Name:LI, ZHANGPENG (MT140071)
Entity type:Individual
Prefix:
First Name:ZHANGPENG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MT140071
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 SPRINGDALE RD APT 2210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-2514
Mailing Address - Country:US
Mailing Address - Phone:512-608-8275
Mailing Address - Fax:
Practice Address - Street 1:7601 SPRINGDALE RD APT 2210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-2514
Practice Address - Country:US
Practice Address - Phone:512-608-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT140071101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101200000XBehavioral Health & Social Service ProvidersDrama TherapistGroup - Single Specialty