Basic Information
| Provider Information | |||||||||
| NPI: | 1164908489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHONG | ||||||||
| FirstName: | KE XIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | CT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1847 | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986328140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604230203 | ||||||||
| FaxNumber: | 3605770269 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 14TH AVE | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307932487 | ||||||||
| FaxNumber: | 3307435748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2018 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.1801062-TRNE | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | CG61025601 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.