Individual
DR. PRISCILLA PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
224 W D.L. INGRAM AVE, BLDG. 1408, CANNON AFB, NM 88103
(575) 784-1108
Mailing address
27 SOMDG, 104 W. D.L. INGRAM AVE, CANNON AFB, NM 88101
(575) 784-1108
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NM
103TC0700X
Clinical Psychologist
Primary
0810008963
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Enumeration date
05/17/2022
Last updated
06/27/2025
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