Individual
CHANEL RENEE NETTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1120 W LA VETA AVE STE 660&470, ORANGE, CA 92868-4231
(714) 509-8210
Mailing address
1120 W LA VETA AVE STE 660&470, ORANGE, CA 92868-4231
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1982384848
CA
390200000X
Student in an Organized Health Care Education/Training Program
1982384848
CA
Other
Enumeration date
07/24/2023
Last updated
10/05/2023
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