Provider Demographics
NPI:1437495900
Name:PHAN, ANTHONY VAN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:VAN
Last Name:PHAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 W METROPOLITAN DR # 120
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3504
Mailing Address - Country:US
Mailing Address - Phone:714-972-3700
Mailing Address - Fax:714-972-3744
Practice Address - Street 1:4000 W METROPOLITAN DR # 120
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3504
Practice Address - Country:US
Practice Address - Phone:714-972-3700
Practice Address - Fax:714-972-3744
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113233106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113233OtherBOARD OF BEHAVIORAL SCIENCE