Basic Information
| Provider Information | |||||||||
| NPI: | 1144654831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | ANHTUAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD, MPH, MHA, CAC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27705 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802270705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203080195 | ||||||||
| FaxNumber: | 3032450119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 WADSWORTH BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802145256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032381488 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2013 | ||||||||
| LastUpdateDate: | 01/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 6852 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.