Provider Demographics
NPI:1538731880
Name:PHAM-METHOT, YNIN (LCSW)
Entity type:Individual
Prefix:
First Name:YNIN
Middle Name:
Last Name:PHAM-METHOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YNIN
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:17595 HARVARD AVE STE C PMB 10069
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8522
Mailing Address - Country:US
Mailing Address - Phone:657-229-2289
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:657-229-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1005721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical