Provider Demographics
NPI:1891177036
Name:PHAM, MAIGEN (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:MAIGEN
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23614 NORCIA CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3802
Mailing Address - Country:US
Mailing Address - Phone:832-247-2790
Mailing Address - Fax:
Practice Address - Street 1:17920 HUFFMEISTER RD STE 150
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6445
Practice Address - Country:US
Practice Address - Phone:832-421-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
TX76472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist