Basic Information
| Provider Information | |||||||||
| NPI: | 1760840672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANCIL | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11835 W OLYMPIC BLVD STE 1265E | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900645814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102734843 | ||||||||
| FaxNumber: | 3102735056 | ||||||||
| Practice Location | |||||||||
| Address1: | 11835 W OLYMPIC BLVD STE 1265E | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900645814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102734843 | ||||||||
| FaxNumber: | 3102735056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 10273 | MA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 28715 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.