Provider Demographics
NPI:1568832632
Name:NELSON, CATHLEEN ANNE MICHELLE (MS)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:ANNE MICHELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:CATHIANNE
Other - Middle Name:MICHELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:380 BOWLINE DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4713
Mailing Address - Country:US
Mailing Address - Phone:831-801-5920
Mailing Address - Fax:
Practice Address - Street 1:380 BOWLINE DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4713
Practice Address - Country:US
Practice Address - Phone:831-801-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist