| Doctor Name: | WALTER WILLIAM NIELSON |
| NPI Number: | 1003183088 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | IMF78099 |
| Business Practice Address: | 908 Tuolumne St Vallejo, CA - 945904641 |
| Business Phone Number: | 7076488121 |
| Business Fax Number: | |
| Mailing Address: | 1191 Schofield Ct, CONCORD |
| State: | CA |
| Postal Code: | 945204019 |
| Phone Number: | 9259617868 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2011 |
| NPI Last Update Date: | 05/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IMF78099 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |