Provider Demographics
NPI:1043585748
Name:TRAN, MICHAEL THANH
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THANH
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 N LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-1229
Mailing Address - Country:US
Mailing Address - Phone:316-519-5097
Mailing Address - Fax:316-361-0679
Practice Address - Street 1:146 N LAMAR AVE
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1229
Practice Address - Country:US
Practice Address - Phone:316-519-5097
Practice Address - Fax:316-361-0679
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS626101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)