Provider Demographics
NPI:1477919025
Name:PHAN, THAO-HA (MA, LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:THAO-HA
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:MA, LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13750 CROSSTOWN DR NW STE 10
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-5853
Mailing Address - Country:US
Mailing Address - Phone:763-265-3331
Mailing Address - Fax:855-221-4223
Practice Address - Street 1:13750 CROSSTOWN DR NW STE 10
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-5853
Practice Address - Country:US
Practice Address - Phone:763-265-3331
Practice Address - Fax:855-221-4223
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303961101YA0400X
MN3210106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)