Healthcare Provider Details

I. General information

NPI: 1457010548
Provider Name (Legal Business Name): MS. TINA PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SANTA ANITA AVE STE 800
ARCADIA CA
91006-3129
US

IV. Provider business mailing address

150 N SANTA ANITA AVE STE 800
ARCADIA CA
91006-3129
US

V. Phone/Fax

Practice location:
  • Phone: 626-604-6240
  • Fax:
Mailing address:
  • Phone: 626-604-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-979
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC18516
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT10000651
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT151829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: