Provider Demographics
NPI:1679774954
Name:MENA-BELL, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MENA-BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29 GRAYLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2219
Mailing Address - Country:US
Mailing Address - Phone:510-332-6746
Mailing Address - Fax:
Practice Address - Street 1:29 GRAYLAWN AVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2219
Practice Address - Country:US
Practice Address - Phone:510-332-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-1063OtherFQHC MEDICARE PART A
CAZZZ29799ZOtherFQHC MEDICARE PART B