Provider Demographics
NPI:1104977990
Name:NELSON, RONALD J (EDD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2965
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-2965
Mailing Address - Country:US
Mailing Address - Phone:520-868-5254
Mailing Address - Fax:520-868-5254
Practice Address - Street 1:480 N. BISBEE AVE
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643
Practice Address - Country:US
Practice Address - Phone:520-384-4211
Practice Address - Fax:520-868-5254
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool