Provider Demographics
NPI:1245456110
Name:PHAM, CHAMBRIELLE THUY (MFT)
Entity type:Individual
Prefix:
First Name:CHAMBRIELLE
Middle Name:THUY
Last Name:PHAM
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 1:4000 BIRCH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2258
Mailing Address - Country:US
Mailing Address - Phone:714-580-2882
Mailing Address - Fax:
Practice Address - Street 1:4000 BIRCH ST STE 203
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2258
Practice Address - Country:US
Practice Address - Phone:714-580-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist