Provider Demographics
NPI:1457986358
Name:PHAM, DIEM KIEU-THI (LPC)
Entity Type:Individual
Prefix:MISS
First Name:DIEM
Middle Name:KIEU-THI
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 1:3422 BUSINESS CENTER DR., STE 106, #106
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1787
Mailing Address - Country:US
Mailing Address - Phone:409-223-7506
Mailing Address - Fax:
Practice Address - Street 1:10203 KIRKDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2311
Practice Address - Country:US
Practice Address - Phone:409-223-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health