Provider Demographics
NPI:1356527832
Name:CHANG, VICTOR Y (PHD, LPC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:Y
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2022
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-0022
Mailing Address - Country:US
Mailing Address - Phone:541-621-4245
Mailing Address - Fax:
Practice Address - Street 1:518 WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1694
Practice Address - Country:US
Practice Address - Phone:541-621-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional