Healthcare Provider Details

I. General information

NPI: 1770504425
Provider Name (Legal Business Name): KARIN ELSA NILSSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 P ST SUITE 203
SACRAMENTO CA
95814-5225
US

IV. Provider business mailing address

2011 P ST SUITE 203
SACRAMENTO CA
95814-5225
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-2966
  • Fax: 916-442-2966
Mailing address:
  • Phone: 916-442-2966
  • Fax: 916-442-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY15136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: