Provider Demographics
NPI:1912711839
Name:GAO, LUYANG
Entity type:Individual
Prefix:
First Name:LUYANG
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12713 ERSKIN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-7495
Mailing Address - Country:US
Mailing Address - Phone:651-246-7161
Mailing Address - Fax:
Practice Address - Street 1:3033 EXCELSIOR BLVD STE 370
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-3259
Practice Address - Country:US
Practice Address - Phone:612-520-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional