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NPI Code Detail

MEDICARE: SHARAYAH BROOKE NELSON CATC

MEDICARE: SHARAYAH BROOKE NELSON CATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor2013658CA
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1285251868
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHARAYAH BROOKE NELSON CATC
Provider Business Mailing Address
First Line : 1525 UNION AVE
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-5049
Country : US
Telephone Number : 707-435-1804
Fax Number :
Provider Business Practice Location Address
First Line : 1525 UNION AVE
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-5049
Country : US
Telephone Number : 707-435-1804
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2020
Last Update Date : 06/30/2020

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