Provider Demographics
NPI:1962663971
Name:NGUYEN, PHUONG THANH (PHD)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 TAUB LOOP
Mailing Address - Street 2:BEN TAUB INPATIENT PSYCHIATY SERVICES, STE 4.229
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1608
Mailing Address - Country:US
Mailing Address - Phone:713-873-4914
Mailing Address - Fax:
Practice Address - Street 1:1502 TAUB LOOP
Practice Address - Street 2:BEN TAUB INPATIENT PSYCHIATY SERVICES, STE 4.229
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36003103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical