Provider Demographics
NPI:1861657934
Name:NASHELSKY, SKYE SIMON
Entity Type:Individual
Prefix:
First Name:SKYE
Middle Name:SIMON
Last Name:NASHELSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 7TH ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6203
Mailing Address - Country:US
Mailing Address - Phone:707-536-1502
Mailing Address - Fax:
Practice Address - Street 1:1385 MISSION ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2623
Practice Address - Country:US
Practice Address - Phone:415-864-4002
Practice Address - Fax:415-864-7093
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist