Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 75856 | CA |
Y | 101YM0800X | Mental Health Counselor | 75856 | CA |
N | 1041C0700X | Clinical Social Worker | 75856 | CA |
NPI | 1003356791 |
---|---|
Provider Name | Nathan Bevens |
First Address | Laytonville, CA 95454-0870 |
Second Address | Laytonville, CA 95454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2017 |
Last Update Date | 17/03/2018 |