Provider Demographics
NPI:1316293681
Name:MAGELSSEN, NELS HAROLD (PSYD)
Entity type:Individual
Prefix:
First Name:NELS
Middle Name:HAROLD
Last Name:MAGELSSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11522 NE 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3025
Mailing Address - Country:US
Mailing Address - Phone:425-455-5868
Mailing Address - Fax:425-637-0699
Practice Address - Street 1:11522 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3025
Practice Address - Country:US
Practice Address - Phone:425-455-5868
Practice Address - Fax:425-637-0699
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1434102L00000X, 103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent