Provider Demographics
NPI:1891083481
Name:NGUYEN, PHUONG MAI (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:MAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:MAI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, LADC, MFT
Mailing Address - Street 1:850 HARVARD WAY
Mailing Address - Street 2:MAIL STOP T5
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:85 KIRMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1340
Practice Address - Country:US
Practice Address - Phone:775-982-2862
Practice Address - Fax:775-982-2865
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCADC-I#01075101YA0400X
NV101YM0800X
NVMFT-I#MI0417106H00000X
225400000X
NV01318106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner