Provider Demographics
NPI:1962181123
Name:DANG, MATTHEW (MA, LPCC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DANG
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 WAYZATA BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:763-544-1006
Mailing Address - Fax:
Practice Address - Street 1:8401 WAYZATA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1343
Practice Address - Country:US
Practice Address - Phone:763-544-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MNCC03966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional