Healthcare Provider Details

I. General information

NPI: 1326696964
Provider Name (Legal Business Name): THIENTRANG THI NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 AMERICAN BLVD E STE 8
BLOOMINGTON MN
55425-1230
US

IV. Provider business mailing address

1801 AMERICAN BLVD E STE 8
BLOOMINGTON MN
55425-1230
US

V. Phone/Fax

Practice location:
  • Phone: 612-767-7222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4819
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: