Provider Demographics
NPI:1285445494
Name:PHAM, TINA THI (BCBA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 PORTWEST DR UNIT 1906955
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-8044
Mailing Address - Country:US
Mailing Address - Phone:832-740-1100
Mailing Address - Fax:
Practice Address - Street 1:6955 PORTWEST DR STE 190
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-8051
Practice Address - Country:US
Practice Address - Phone:832-740-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-24-78662103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst