Provider Demographics
NPI:1821006230
Name:NYLUND, DAVID KEITH (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
Last Name:NYLUND
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 EXPOSITION BLVD
Mailing Address - Street 2:#122
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-5100
Mailing Address - Country:US
Mailing Address - Phone:916-743-7281
Mailing Address - Fax:
Practice Address - Street 1:5523 34TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4725
Practice Address - Country:US
Practice Address - Phone:916-452-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS144631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical