Basic Information
| Provider Information | |||||||||
| NPI: | 1164739405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS-NELSON | ||||||||
| FirstName: | GAELEN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1266 14TH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946072205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105313111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 23RD ST | ||||||||
| Address2: | BUILDING 9, ROOM 130 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152065270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2010 | ||||||||
| LastUpdateDate: | 07/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 74642. | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.