Individual
KOOB PHONG LESANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1811 WEIR DR STE 270, WOODBURY, MN 55125-6741
(651) 714-9646
Mailing address
1789 HAWTHORNE AVE E, SAINT PAUL, MN 55119-4528
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
3694
MN
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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