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General NPI Number Information
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NPI Number | 1497303655
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Entity Type | Individual
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Provider Name | CHARLES RICHARD NESBITT JR. LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/30/2019
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 515 N PALM CANYON DR BLDG H
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5543
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Country | US
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Telephone | 760-459-6115
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Fax |
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Provider Business Mailing Address
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Address Line | 515 N PALM CANYON DR BLDG H
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5543
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Country | US
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Telephone | 760-459-6115
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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 | 106972
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT106972
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 133200
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License Number State | CA
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