Provider Demographics
NPI:1568009751
Name:PHAM, LANEY THIEN
Entity Type:Individual
Prefix:
First Name:LANEY
Middle Name:THIEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 BROOKLYN AVE NE APT 302
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4983
Mailing Address - Country:US
Mailing Address - Phone:503-737-8699
Mailing Address - Fax:
Practice Address - Street 1:5001 BROOKLYN AVE NE APT 302
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4983
Practice Address - Country:US
Practice Address - Phone:503-737-8699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician