Provider Demographics
NPI:1790941771
Name:LAM-TRAN, JUDY (MFT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:LAM-TRAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 GRANITE DR.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-594-5288
Mailing Address - Fax:
Practice Address - Street 1:920 GRANITE DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-594-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2019-03-18
Deactivation Date:2019-02-25
Deactivation Code:
Reactivation Date:2019-03-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7184OtherMEDICAL
CA7368OtherMEDICAL
CA7667OtherMEDICAL
CA7708OtherMEDICAL