Provider Demographics
NPI:1407441777
Name:GASTELUM, NANCY MARIE (MS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:GASTELUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:MARIE
Other - Last Name:GASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 VILLAGE DR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3067
Mailing Address - Country:US
Mailing Address - Phone:805-264-0854
Mailing Address - Fax:
Practice Address - Street 1:400 W PARK AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-6116
Practice Address - Country:US
Practice Address - Phone:805-925-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9320101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional