Provider Demographics
NPI:1740355114
Name:NELSON, ROBERT WILLIAM JR (MENTAL HEALTH WORKER)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:MENTAL HEALTH WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 RIO LINDO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1817
Mailing Address - Country:US
Mailing Address - Phone:181-820-6036
Mailing Address - Fax:530-345-0261
Practice Address - Street 1:590 RIO LINDO AVE
Practice Address - Street 2:590 RIO LINDO
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1817
Practice Address - Country:US
Practice Address - Phone:530-345-3349
Practice Address - Fax:530-345-0261
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)