Provider Demographics
NPI:1386762664
Name:VILLAR, NHU-TAM PHAM (MA LCADC NCC)
Entity type:Individual
Prefix:MS
First Name:NHU-TAM
Middle Name:PHAM
Last Name:VILLAR
Suffix:
Gender:F
Credentials:MA LCADC NCC
Other - Prefix:MRS
Other - First Name:NHU-TAM
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LADC NCC
Mailing Address - Street 1:6375 W CHARLESTON BLVD
Mailing Address - Street 2:172
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1139
Mailing Address - Country:US
Mailing Address - Phone:702-877-0684
Mailing Address - Fax:702-877-2108
Practice Address - Street 1:6375 W CHARLESTON BLVD
Practice Address - Street 2:STE A-172
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1139
Practice Address - Country:US
Practice Address - Phone:702-877-0684
Practice Address - Fax:702-877-2108
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV217655101Y00000X
NV1146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNCC 217655OtherNV NATIOANL BOARD
NV1146 LCDCOtherLICENSE
NV100500484Medicaid
NV1146 LADCOtherLADC LICENSE
NV3015OtherLICENSE
NV3015OtherLICENSE