Healthcare Provider Details

I. General information

NPI: 1659866390
Provider Name (Legal Business Name): THANH TAM NGUYEN-LOUIE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAM NGUYEN-LOUIE PHD

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 FREDERICK RD
CATONSVILLE MD
21228-5055
US

IV. Provider business mailing address

4520 RUSTY GATE
ELLICOTT CITY MD
21043-6565
US

V. Phone/Fax

Practice location:
  • Phone: 443-355-7572
  • Fax:
Mailing address:
  • Phone: 858-361-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number06548
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06548
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: