Provider Demographics
NPI:1760891469
Name:PILLAY, VAN NGUYEN
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:NGUYEN
Last Name:PILLAY
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 1:8238 HOLLYGRAPE LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80927-4055
Mailing Address - Country:US
Mailing Address - Phone:714-625-1549
Mailing Address - Fax:
Practice Address - Street 1:8238 HOLLYGRAPE LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80927-4055
Practice Address - Country:US
Practice Address - Phone:714-625-1549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106H00000X
CAIMF91689106H00000X
CA125097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health