Provider Demographics
NPI:1144395013
Name:PHAM, THUY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THUY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607A CALIFORNIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209
Mailing Address - Country:US
Mailing Address - Phone:847-863-4975
Mailing Address - Fax:847-843-7393
Practice Address - Street 1:5244 LYNGATE COURT, SUITE 200
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-910-2577
Practice Address - Fax:703-661-9463
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical