Basic Information
| Provider Information | |||||||||
| NPI: | 1215245865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | NGOCTRANG | ||||||||
| MiddleName: | THI | ||||||||
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| Credential: | |||||||||
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| OtherLastName: | TRAN | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 580491 | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957580009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168806986 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7000 FRANKLIN BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958231865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163940800 | ||||||||
| FaxNumber: | 9164297824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2010 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.