Provider Demographics
NPI:1730959230
Name:LE, BAO-CHAU (PMHNP)
Entity type:Individual
Prefix:DR
First Name:BAO-CHAU
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3278 BEAR MOUNTAIN DR APT 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4546
Mailing Address - Country:US
Mailing Address - Phone:808-687-1173
Mailing Address - Fax:
Practice Address - Street 1:3278 BEAR MOUNTAIN DR APT 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4546
Practice Address - Country:US
Practice Address - Phone:808-687-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2023089110364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Single Specialty