Provider Demographics
NPI:1174667596
Name:JUNG, NANCY SHIN-YII (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SHIN-YII
Last Name:JUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 SW WESTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7727
Mailing Address - Country:US
Mailing Address - Phone:479-715-6739
Mailing Address - Fax:
Practice Address - Street 1:5105 SW WESTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7727
Practice Address - Country:US
Practice Address - Phone:479-715-6739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT307875OtherHEALTHNET-MHN
CT307875OtherHEALTHNET-MHN