Provider Demographics
NPI:1932321486
Name:NGUYEN-KELLY, THANH SON THI (PHD, LP, DABPS)
Entity Type:Individual
Prefix:DR
First Name:THANH SON
Middle Name:THI
Last Name:NGUYEN-KELLY
Suffix:
Gender:F
Credentials:PHD, LP, DABPS
Other - Prefix:DR
Other - First Name:THANH SON
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP, DABPS
Mailing Address - Street 1:2134 BELMONT LANE EAST
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109
Mailing Address - Country:US
Mailing Address - Phone:651-917-8888
Mailing Address - Fax:
Practice Address - Street 1:1315 WEST LARPENTEUR SUITE I
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-645-8080
Practice Address - Fax:651-645-8181
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4596103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist