Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY32739 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY32739 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1073091369 |
---|---|
Provider Name | Michael Nutt |
First Address | Culver City, CA 90230-4820 |
Second Address | Inglewood, CA 90301-4502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2018 |
Last Update Date | 25/08/2021 |