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General NPI Number Information
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NPI Number | 1417760141
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Entity Type | Individual
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Provider Name | JARED NILSSON
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Gender | Male
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1360 N MAIN ST STE 124
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City | BISHOP
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State | CA
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Zip | 93514-3013
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Country | US
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Telephone | 760-874-3613
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 N. MAIN STE SUITE 124
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City | BISHOP
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State | CA
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Zip | 93514
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Country | US
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Telephone | 760-937-1454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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