Healthcare Provider Details

I. General information

NPI: 1740355114
Provider Name (Legal Business Name): ROBERT WILLIAM NELSON JR. MENTAL HEALTH WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 RIO LINDO AVE 590 RIO LINDO
CHICO CA
95926-1817
US

IV. Provider business mailing address

590 RIO LINDO AVE
CHICO CA
95926-1817
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-3349
  • Fax: 530-345-0261
Mailing address:
  • Phone: 181-820-6036
  • Fax: 530-345-0261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: