Provider Demographics
NPI:1255536793
Name:LY, NGUYET ANH (MFT)
Entity type:Individual
Prefix:MISS
First Name:NGUYET
Middle Name:ANH
Last Name:LY
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 1:654 W SUNNYOAKS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5343
Mailing Address - Country:US
Mailing Address - Phone:408-885-3931
Mailing Address - Fax:408-885-7544
Practice Address - Street 1:871 ENBORG CT UNIT 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2645
Practice Address - Country:US
Practice Address - Phone:408-885-3931
Practice Address - Fax:408-885-7544
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist