Provider Demographics
NPI:1184927576
Name:RUST, NANCY LEE
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:RUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-2443
Mailing Address - Country:US
Mailing Address - Phone:805-922-1437
Mailing Address - Fax:805-614-4614
Practice Address - Street 1:1062 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-2443
Practice Address - Country:US
Practice Address - Phone:805-922-1437
Practice Address - Fax:805-614-4614
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMFT57821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health