Provider Demographics
NPI:1710343983
Name:NUON, THIDA
Entity Type:Individual
Prefix:
First Name:THIDA
Middle Name:
Last Name:NUON
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 1:3122 N MILLBROOK AVE STE F
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1458
Mailing Address - Country:US
Mailing Address - Phone:559-558-8267
Mailing Address - Fax:559-228-9714
Practice Address - Street 1:3122 N MILLBROOK AVE STE F
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1458
Practice Address - Country:US
Practice Address - Phone:559-558-8267
Practice Address - Fax:559-228-9714
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF88100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist