Individual provider Active NPI

Thu Bao Anh Nguyen, PSYD

  • Clinical Child & Adolescent Psychologist
  • League City, TX
National Provider Identifier
1972322840
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
40132 Issued in TX
Practice address
2785 Gulf Fwy S Ste 2.200
League City, TX 77573-4979
Phone
(409) 772-3695
NPI assigned
Oct 8, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 40132 TX Primary

Addresses

Primary practice location

2785 Gulf Fwy S Ste 2.200
League City, TX 77573-4979

Mailing address

17611 Trinity Meadow LN
Richmond, TX 77407-1987
Phone (832) 282-1729

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20241204000854 TX Practitioner - Clinical Psychologist 9638605470 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40132TXMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice CurrentSince Dec 5, 2024 Accepting new patients
University of Texas Medical Branch at Galveston PastSince Oct 13, 2024 Accepting new patients

Locations

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

2785 Gulf Fwy S
Ste 2200
League City, TX 77573
Phone (409) 772-3695

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1972322840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17611 TRINITY MEADOW LN",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774071987",
            "telephone_number": "832-282-1729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2785 GULF FWY S STE 2.200",
            "city": "LEAGUE CITY",
            "state": "TX",
            "postal_code": "775734979",
            "telephone_number": "409-772-3695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "THU",
        "middle_name": "BAO ANH",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "TX",
            "license": "40132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in League City, TX

Sources for this page

Verify at the official NPI Registry.