Individual
CAMILLA HANNAH NYSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1255 KENDALL RD, SAN LUIS OBISPO, CA 93401-8750
(805) 781-3535
Mailing address
1255 KENDALL RD, SAN LUIS OBISPO, CA 93401-8750
(541) 686-1262
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
CA
101YM0800X
Mental Health Counselor
—
OR
225C00000X
Rehabilitation Counselor
—
—
Other
Enumeration date
12/03/2013
Last updated
10/20/2021
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