Basic Information
| Provider Information | |||||||||
| NPI: | 1952656852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | MINERVA | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUERTA | ||||||||
| OtherFirstName: | MINERVA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1927 | ||||||||
| Address2: | |||||||||
| City: | BIG BEAR LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923151927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098665070 | ||||||||
| FaxNumber: | 9098783228 | ||||||||
| Practice Location | |||||||||
| Address1: | 41945 BIG BEAR BLVD | ||||||||
| Address2: | |||||||||
| City: | BIG BEAR LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098665070 | ||||||||
| FaxNumber: | 9098773228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.