Provider Demographics
NPI:1215815733
Name:PHAN, CHAM PAULINA THANH (BCBA)
Entity type:Individual
Prefix:
First Name:CHAM
Middle Name:PAULINA THANH
Last Name:PHAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CHAM
Other - Middle Name:THANH
Other - Last Name:CHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:648 CAMERON CT
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2604
Mailing Address - Country:US
Mailing Address - Phone:504-505-4352
Mailing Address - Fax:386-382-4353
Practice Address - Street 1:4224 FLORIDA AVE STE 5
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1390
Practice Address - Country:US
Practice Address - Phone:504-505-4352
Practice Address - Fax:386-382-4353
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-1013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst