Healthcare Provider Details

I. General information

NPI: 1235042656
Provider Name (Legal Business Name): VIVIAN TRUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3034 W WELLINGTON AVE APT 1
CHICAGO IL
60618-8561
US

IV. Provider business mailing address

3034 W WELLINGTON AVE APT 1
CHICAGO IL
60618-8561
US

V. Phone/Fax

Practice location:
  • Phone: 412-961-3822
  • Fax:
Mailing address:
  • Phone: 412-961-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.033354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: