Most Relevant Information
Provider Data
| NPI Number: | 1003428178 |
| Provider Name: | CHLOE VONGPHACHANH |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | 20131374 |
Most Important Dates
| Enumeration Date: | 08/20/2020 |
| Last Updated: | 09/25/2024 |
Provider Practice Location
2425 E SOUTHLAKE BLVD
SOUTHLAKE
TX
760926674
Practice Location Phone/Fax
| Phone: | 8174420222 |
| Fax: |
Provider Mailing Location
2425 E SOUTHLAKE BLVD
SOUTHLAKE
TX
760926674
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |