Individual provider Active NPI

Tina Tran, LPC

  • Mental Health Counselor
  • Tempe, AZ
National Provider Identifier
1942603154
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LPC-18535 Issued in AZ
Practice address
2120 S McClintock Dr
Suite 105
Tempe, AZ 85282-2692
Phone
(480) 804-0326
Fax
(480) 804-0083
NPI assigned
Oct 1, 2014
Last updated
Jun 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LAC-15245 AZ
Mental Health Counselor 101YM0800X LPC-18535 AZ Primary

Addresses

Primary practice location

2120 S McClintock Dr
Suite 105
Tempe, AZ 85282-2692

Mailing address

1400 E. Southern Ave
Ste. 735
Tempe, AZ 85282-2692
Phone (480) 804-0326

Other names 1

  • Tina Tran Kimbrough Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240104001839 AZ Practitioner - Mental Health Counselor 1254782139

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LAC-15245AZMDMental Health Counselor
LPC-18535AZMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1942603154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E. SOUTHERN AVE",
            "address_2": "STE. 735",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852822692",
            "telephone_number": "480-804-0326",
            "fax_number": "480-804-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 S MCCLINTOCK DR",
            "address_2": "SUITE 105",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852822692",
            "telephone_number": "480-804-0326",
            "fax_number": "480-804-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "TINA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-01",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LAC-15245",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LPC-18535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "KIMBROUGH",
            "middle_name": "TRAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tempe, AZ

Sources for this page

Verify at the official NPI Registry.