Basic Information
| Provider Information | |||||||||
| NPI: | 1699089243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | LYNAE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 MEADOWS ROAD | ||||||||
| Address2: | SUITE #300 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970350026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712011720 | ||||||||
| FaxNumber: | 5417262467 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 MEADOWS ROAD | ||||||||
| Address2: | SUITE #300 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970350026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712011720 | ||||||||
| FaxNumber: | 5417262467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2010 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | C4674 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.