Provider Demographics
NPI:1104029784
Name:NANCY D YOUNG PHD
Entity Type:Organization
Organization Name:NANCY D YOUNG PHD
Other - Org Name:PATHWAYS TO WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT &OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHENIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:714-432-9856
Mailing Address - Street 1:2845 MESA VERDE DR E
Mailing Address - Street 2:SUITE 8
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4858
Mailing Address - Country:US
Mailing Address - Phone:714-432-9856
Mailing Address - Fax:714-432-7075
Practice Address - Street 1:2845 MESA VERDE DR E
Practice Address - Street 2:SUITE 8
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4858
Practice Address - Country:US
Practice Address - Phone:714-432-9856
Practice Address - Fax:714-432-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20804103TC0700X
CAPSY 11961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396787156OtherNPI FOR JUDY FLUOR RUNELS
CA1205862224OtherNPI FOR NANCY D YOUNG PHD
CA1396787156OtherNPI FOR JUDY FLUOR RUNELS
CAWCP20804AMedicare ID - Type UnspecifiedGROUP ID