Provider Demographics
NPI:1598839219
Name:WILLANS, MARTIN NELSON (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:NELSON
Last Name:WILLANS
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7022
Mailing Address - Country:US
Mailing Address - Phone:760-320-5651
Mailing Address - Fax:760-416-2061
Practice Address - Street 1:2225 TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7022
Practice Address - Country:US
Practice Address - Phone:760-320-5651
Practice Address - Fax:760-416-2061
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS56831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7948633Medicaid
CA7948633Medicaid