Provider Demographics
NPI:1790185973
Name:CHASTAIN, PHUONG NGUYEN (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:NGUYEN
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NE 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-1243
Mailing Address - Country:US
Mailing Address - Phone:515-309-1802
Mailing Address - Fax:515-289-1281
Practice Address - Street 1:401 NE 66TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-1243
Practice Address - Country:US
Practice Address - Phone:515-309-1802
Practice Address - Fax:515-289-1281
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health