Provider Demographics
NPI:1245858026
Name:PHUNG-SMITH, NANCY (LMFT138181)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:PHUNG-SMITH
Suffix:
Gender:F
Credentials:LMFT138181
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 27TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8461 ILDICA ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-4274
Practice Address - Country:US
Practice Address - Phone:619-736-1284
Practice Address - Fax:619-567-2726
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138181106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty