RUSSELL GLENN NELSON

SAN LUIS OBISPO, CA
NPI1124298732
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2008-03-11
Last Update Date2013-10-03
Business Address
-- RUSSELL GLENN NELSON
2180 JOHNSON AVE
SAN LUIS OBISPO, CA 93401-4513
Phone number: 805-788-2524
Mailing Address
-- RUSSELL GLENN NELSON
2180 JOHNSON AVE
SAN LUIS OBISPO, CA 93401-4513
Phone number: 805-489-6681
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