Provider Demographics
NPI:1326639824
Name:PHAN, VIVIAN (LMFT)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16410 JODY CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7863
Mailing Address - Country:US
Mailing Address - Phone:714-717-3800
Mailing Address - Fax:
Practice Address - Street 1:17814 WOODRUFF AVE STE 3
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-7000
Practice Address - Country:US
Practice Address - Phone:562-925-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124015106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist