Provider Demographics
NPI:1124307640
Name:NELSON, TARUS GEROME
Entity type:Individual
Prefix:
First Name:TARUS
Middle Name:GEROME
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 MOSS BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8536
Mailing Address - Country:US
Mailing Address - Phone:702-686-8482
Mailing Address - Fax:
Practice Address - Street 1:6471 MOSS BLUFF CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-8536
Practice Address - Country:US
Practice Address - Phone:702-686-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor