Healthcare Provider Details

I. General information

NPI: 1679382618
Provider Name (Legal Business Name): NANCY TRUONG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HEARTHSTONE WAY APT 4168
CHANDLER AZ
85226-0047
US

IV. Provider business mailing address

100 N HEARTHSTONE WAY APT 4168
CHANDLER AZ
85226-0047
US

V. Phone/Fax

Practice location:
  • Phone: 220-666-4150
  • Fax:
Mailing address:
  • Phone: 220-666-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number005316
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: