NPIMap

Organization Active NPI

Nancy D Young PHD

  • Clinical Psychologist
  • Costa Mesa, CA
National Provider Identifier
1104029784
Registry record updated Sep 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 11961 Issued in CA
Legal business name
NANCY D YOUNG PHD
Practice address
2845 Mesa Verde Dr E
Suite 8
Costa Mesa, CA 92626-4858
Phone
(714) 432-9856
Fax
(714) 432-7075
NPI assigned
Jun 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephenie Champlin, BA
Title
Executive Assistant &Office Manager
Phone
(714) 432-9856

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PSY 20804 CA
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PSY 11961 CA Primary

Addresses

Primary practice location

2845 Mesa Verde Dr E
Suite 8
Costa Mesa, CA 92626-4858

Mailing address

2845 Mesa Verde Dr E
Suite 8
Costa Mesa, CA 92626-4858
Phone (714) 432-9856

Other identifiers 2

IdentifierTypeStateIssuer
1396787156OtherCANPI FOR JUDY FLUOR RUNELS
1205862224OtherCANPI FOR NANCY D YOUNG PHD

Other names 1

  • Pathways to Wellness Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Nancy D Young PHD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2845 Mesa Verde Dr E
Ste 8
Costa Mesa, CA 92626
Phone (714) 432-9856

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1104029784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 MESA VERDE DR E",
            "address_2": "SUITE 8",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264858",
            "telephone_number": "714-432-9856",
            "fax_number": "714-432-7075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 MESA VERDE DR E",
            "address_2": "SUITE 8",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264858",
            "telephone_number": "714-432-9856",
            "fax_number": "714-432-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANCY D YOUNG PHD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-08",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "CHAMPLIN",
        "authorized_official_first_name": "STEPHENIE",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT &OFFICE MANAGER",
        "authorized_official_telephone_number": "714-432-9856",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 20804",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 11961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR JUDY FLUOR RUNELS",
            "identifier": "1396787156",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR NANCY D YOUNG PHD",
            "identifier": "1205862224",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pathways to Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.