Provider Demographics
NPI:1336356187
Name:MORGAN, NANCY LYNN (MS, PHD)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEAR PAW
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-8014
Mailing Address - Country:US
Mailing Address - Phone:925-323-6885
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7930
Practice Address - Country:US
Practice Address - Phone:925-825-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3815101YP2500X
CAPSY 23397103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional