Provider Demographics
NPI:1437885233
Name:VANNAVONG, THONGSOUK (LCPC)
Entity Type:Individual
Prefix:
First Name:THONGSOUK
Middle Name:
Last Name:VANNAVONG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 TORNGATE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-0106
Mailing Address - Country:US
Mailing Address - Phone:702-810-4655
Mailing Address - Fax:
Practice Address - Street 1:375 N STEPHANIE ST STE 8
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8771
Practice Address - Country:US
Practice Address - Phone:702-294-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5150-R101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health