Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MFT12314 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY13930 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY13930 | CA |
Y | 103G00000X | Clinical Psychologist | PSY13930 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY13930 | CA |
N | 103TC1900X | Counseling Psychologist | PSY13930 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY13930 | CA |
N | 103TF0000X | Family Psychologist | PSY13930 | CA |
N | 103TH0004X | Health Psychologist | PSY13930 | CA |
NPI | 1588614846 |
---|---|
Provider Name | Dr. Butler Nelson |
First Address | Richmond, CA 94801-4199 |
Second Address | Berkeley, CA 94705-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 28/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OOPL13930 | (02) | CA |