Individual provider · Type 1 NPI
Tommy Phoukhaothong Panyanouvong
Peer Specialist · Modesto, CA
NPI number
1407126469
Active
Practice location
1300 Payne Ave
Modesto, CA 95351-4821
Mailing address
800 Scenic Dr
Modesto, CA 95350-6131
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Companion | 372600000X | MPSSIUXREV (CA) |
| Adult Companion | 372600000X | MPSS-IUXREV (CA) |
| Peer Specialist Primary | 175T00000X | MPSS-IUXREV (CA) |
Peer Specialist: Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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About NPI 1407126469
Tommy Phoukhaothong Panyanouvong's National Provider Identifier is 1407126469, issued on Jan 9, 2012. The primary taxonomy on file is Peer Specialist (175T00000X), and the practice location is in Modesto, CA. The record was last updated on May 21, 2025.