Provider Demographics
NPI:1710021480
Name:PARSON, NANCY I (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:I
Last Name:PARSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5657 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3740
Mailing Address - Country:US
Mailing Address - Phone:323-931-3123
Mailing Address - Fax:323-938-4068
Practice Address - Street 1:5657 WILSHIRE BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90036-3740
Practice Address - Country:US
Practice Address - Phone:323-931-3123
Practice Address - Fax:323-938-4068
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP13771Medicare UPIN