Provider Demographics
NPI:1760733380
Name:TRAN, BACH-TY THI
Entity Type:Individual
Prefix:
First Name:BACH-TY
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TY
Other - Middle Name:BACH THI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 CHASE WAY
Mailing Address - Street 2:#B
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-3895
Mailing Address - Country:US
Mailing Address - Phone:310-404-9544
Mailing Address - Fax:
Practice Address - Street 1:80 CHASE WAY
Practice Address - Street 2:#B
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-3895
Practice Address - Country:US
Practice Address - Phone:310-404-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker