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General NPI Number Information
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NPI Number | 1598839219
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Entity Type | Individual
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Provider Name | MARTIN NELSON WILLANS MSW LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2225 TAHQUITZ CANYON WAY SUITE 5
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7022
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Country | US
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Telephone | 760-320-5651
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Fax | 760-416-2061
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Provider Business Mailing Address
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Address Line | 2225 TAHQUITZ CANYON WAY SUITE 5
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7022
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Country | US
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Telephone | 760-320-5651
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Fax | 760-416-2061
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS5683
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License Number State | CA
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