| Doctor Name: | NANCY WAITE-O'BRIEN |
| NPI Number: | 1528450384 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | PSY13350 |
| Business Practice Address: | 59985 Hop Patch Spring Rd Mountain Center, CA - 925614023 |
| Business Phone Number: | 7602758598 |
| Business Fax Number: | 9516590401 |
| Mailing Address: | 59985 Hop Patch Spring Rd, MOUNTAIN CENTER |
| State: | CA |
| Postal Code: | 925614023 |
| Phone Number: | 7602758598 |
| Fax Number: | 9516590401 |
| NPI Enumeration Date: | 03/03/2015 |
| NPI Last Update Date: | 03/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | PSY13350 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |