Provider Demographics
NPI:1144624123
Name:MINGO, CHIANTI (LPC)
Entity type:Individual
Prefix:MS
First Name:CHIANTI
Middle Name:
Last Name:MINGO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 S WESTMORELAND RD APT 1936
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3332
Mailing Address - Country:US
Mailing Address - Phone:716-529-9303
Mailing Address - Fax:
Practice Address - Street 1:3560 W CAMP WISDOM RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2506
Practice Address - Country:US
Practice Address - Phone:214-266-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005352101YM0800X
TX88417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health