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General NPI Number Information
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NPI Number | 1104029784
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Entity Type | Organization
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Legal Business Name | NANCY D YOUNG PHD
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 2845 MESA VERDE DR E SUITE 8
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City | COSTA MESA
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State | CA
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Zip | 92626-4858
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Country | US
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Telephone | 714-432-9856
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Fax | 714-432-7075
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Provider Business Mailing Address
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Address Line | 2845 MESA VERDE DR E SUITE 8
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City | COSTA MESA
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State | CA
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Zip | 92626-4858
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Country | US
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Telephone | 714-432-9856
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Fax | 714-432-7075
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT &OFFICE MANAGER
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Name | STEPHENIE CHAMPLIN
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Credential | BA
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Telephone | 714-432-9856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 20804
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 11961
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License Number State | CA
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