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General NPI Number Information
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NPI Number | 1760819247
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Entity Type | Individual
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Provider Name | DARYN S NIMMO
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Gender | Male
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 720 WOOD ST
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City | EUREKA
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State | CA
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Zip | 95501-4413
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Country | US
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Telephone | 510-593-3237
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 183
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City | EUREKA
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State | CA
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Zip | 95502-0183
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Country | US
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Telephone | 510-593-3237
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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 | 51822
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License Number State | CA
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