Provider Demographics
NPI:1063251122
Name:NELSON, MAUREEN MARIE (MA IN COUNSELING)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA IN COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 SW STEEPLECHASE CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-0418
Mailing Address - Country:US
Mailing Address - Phone:503-382-9210
Mailing Address - Fax:
Practice Address - Street 1:7929 SW CIRRUS DR # 23
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5971
Practice Address - Country:US
Practice Address - Phone:503-382-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional