Provider Demographics
NPI:1932800422
Name:NGUYEN, THY PHUONG (CSWI)
Entity Type:Individual
Prefix:MS
First Name:THY
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 HIGHLAND VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5700
Mailing Address - Country:US
Mailing Address - Phone:310-597-8299
Mailing Address - Fax:
Practice Address - Street 1:205 HATTERAS AVE STE 105
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6502
Practice Address - Country:US
Practice Address - Phone:352-348-8858
Practice Address - Fax:352-708-5603
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health