Provider Demographics
NPI:1376677237
Name:NANNA, URSULA (MFT)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:
Last Name:NANNA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:URSULA
Other - Middle Name:
Other - Last Name:WANLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1075 E SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2244
Mailing Address - Country:US
Mailing Address - Phone:408-299-8658
Mailing Address - Fax:408-298-0192
Practice Address - Street 1:1075 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2244
Practice Address - Country:US
Practice Address - Phone:408-299-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist