Provider Demographics
NPI:1679926679
Name:CHANG, MARK (LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S JUPITER RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7708
Mailing Address - Country:US
Mailing Address - Phone:972-272-4429
Mailing Address - Fax:
Practice Address - Street 1:1738 N JUPITER RD
Practice Address - Street 2:1104
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8699
Practice Address - Country:US
Practice Address - Phone:214-538-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health