Provider Demographics
NPI:1104495787
Name:NELSON, ALEXIS LEE (MA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:LEE
Other - Last Name:FLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3180 CROW CANYON PL STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3180 CROW CANYON PL STE 140
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1339
Practice Address - Country:US
Practice Address - Phone:925-820-1467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA150714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health