Dustin Khanh Phan, LICSWA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

SC61599639 Issued in WA

Practice address

3800 S Othello St
Seattle, WA 98118-3562

Phone

(706) 633-0405

NPI assigned

Jan 24, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Seattle'S Union Gospel Mission

  • Mental Health Counselor
  • Seattle, WA
  • NPI 1447943840
  NPD

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

{
    "created_epoch": "1737676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1992517965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5630 CALIFORNIA AVE SW APT 11",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981361534",
            "telephone_number": "706-633-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 S OTHELLO ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981183562",
            "telephone_number": "706-633-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "DUSTIN",
        "middle_name": "KHANH",
        "credential": "LICSWA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-24",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "SC61599639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Van Pham, DC
• Vicky Pham
• Victoria Anhthu Pham, PHARMD
• Bao Ngoc Thi Phan, PA-C
• Diane Phan, OTR
• Hien-Thao Phan, LICSW, MSW
• Hiep Phan, LPN
• Huynh Anh Duy Phan, CST
• Janet Phan
• Kim Phan

• Mental Health Counselor in Seattle, WA
• Providers in Seattle, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.