MEDICARE: MR. MARTIN NELSON WILLANS MSW LCSW

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
1	1041C0700X	Clinical Social Worker	LCS5683	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598839219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTIN NELSON WILLANS MSW LCSW

Provider Business Mailing Address
First Line	:	2225 TAHQUITZ CANYON WAY
Second Line	:	SUITE 5
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7022
Country	:	US
Telephone Number	:	760-320-5651
Fax Number	:	760-416-2061

Provider Business Practice Location Address
First Line	:	2225 TAHQUITZ CANYON WAY
Second Line	:	SUITE 5
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7022
Country	:	US
Telephone Number	:	760-320-5651
Fax Number	:	760-416-2061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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