Provider Demographics
NPI:1952131781
Name:BRAUNHUT, NANCY LYNN (MS, MAT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:BRAUNHUT
Suffix:
Gender:F
Credentials:MS, MAT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LYNN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 COURTYARD DR APT C
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3562
Mailing Address - Country:US
Mailing Address - Phone:831-254-5661
Mailing Address - Fax:
Practice Address - Street 1:4630 SOQUEL DR STE 10
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-3101
Practice Address - Country:US
Practice Address - Phone:831-222-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health