Basic Information
| Provider Information | |||||||||
| NPI: | 1861657934 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASHELSKY | ||||||||
| FirstName: | SKYE | ||||||||
| MiddleName: | SIMON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 7TH ST UNIT C | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954016203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075361502 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1385 MISSION ST | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158644002 | ||||||||
| FaxNumber: | 4158647093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2008 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 89418 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.