Provider Demographics
NPI:1831601731
Name:ZUPANCIC NAGASHIMA, MARY (MFT INTERN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:ZUPANCIC NAGASHIMA
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:NAGASHIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:4780 FERRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4780 FERRINGTON CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-5378
Practice Address - Country:US
Practice Address - Phone:530-262-0068
Practice Address - Fax:530-410-6995
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist