Provider Demographics
NPI:1790835767
Name:NANSEL, CHARLENE LENORA (MA)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:LENORA
Last Name:NANSEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:GERBER
Mailing Address - State:CA
Mailing Address - Zip Code:96035-0516
Mailing Address - Country:US
Mailing Address - Phone:530-366-1810
Mailing Address - Fax:
Practice Address - Street 1:109 PARMAC RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2294
Practice Address - Country:US
Practice Address - Phone:530-891-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47166106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist