Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY24588 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY24588 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY24588 | CA |
N | 103G00000X | Clinical Psychologist | PSY24588 | CA |
N | 103TC0700X | Clinical Psychologist | PSY24588 | CA |
N | 103TC1900X | Counseling Psychologist | PSY24588 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY24588 | CA |
NPI | 1376759274 |
---|---|
Provider Name | Ms. Nancy Underwood |
First Address | Nipomo, CA 93444-2172 |
Second Address | Nipomo, CA 93444-9131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 17/03/2018 |