Provider Demographics
NPI:1285124081
Name:NELSON, JAMA LYNN (QMHA)
Entity type:Individual
Prefix:MS
First Name:JAMA
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87127 CHRISTMAS VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:CHRISTMAS VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97641-2298
Mailing Address - Country:US
Mailing Address - Phone:541-947-6021
Mailing Address - Fax:541-576-3000
Practice Address - Street 1:215 N G ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1417
Practice Address - Country:US
Practice Address - Phone:541-947-6021
Practice Address - Fax:541-947-6020
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20-10-24101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR930577593Medicaid