Provider Demographics
NPI:1205694262
Name:PHAM, TRUONG SAN-NHI (LPC)
Entity type:Individual
Prefix:
First Name:TRUONG
Middle Name:SAN-NHI
Last Name:PHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MYSTIC RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-7114
Mailing Address - Country:US
Mailing Address - Phone:832-317-4082
Mailing Address - Fax:
Practice Address - Street 1:506 HONEA EGYPT RD STE 401
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2568
Practice Address - Country:US
Practice Address - Phone:346-637-4274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86459101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional