Provider Demographics
NPI:1568594000
Name:CHAMPLIN, MINH-TRAN (PSYD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MINH-TRAN
Middle Name:
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:DR
Other - First Name:MAI
Other - Middle Name:
Other - Last Name:CHAMPLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD, LCSW
Mailing Address - Street 1:PO BOX 11018
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-0018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6527
Practice Address - Country:US
Practice Address - Phone:510-869-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21265103TC0700X
CA171361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical