Provider Demographics
NPI:1790952141
Name:WORSHAM, NANCY L (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:WORSHAM
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 1:203 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2105
Mailing Address - Country:US
Mailing Address - Phone:509-570-3511
Mailing Address - Fax:
Practice Address - Street 1:EAST 502 BOONE AVE
Practice Address - Street 2:GONZAGA UNIVERSITY PSYCHOLOGY DEPARTMENT
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99258-0056
Practice Address - Country:US
Practice Address - Phone:509-323-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2374103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent