Basic Information
| Provider Information | |||||||||
| NPI: | 1326067943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6683 BALLINGER AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921191822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196002294 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1738 S TREMONT ST | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920545309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604392800 | ||||||||
| FaxNumber: | 7604335031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 04/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH1970 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.