Provider Demographics
NPI:1316614522
Name:NELSON, WHITNEY ALLYSE (ACMHC)
Entity type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:ALLYSE
Last Name:NELSON
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 S 5400 W
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-9578
Mailing Address - Country:US
Mailing Address - Phone:801-644-4309
Mailing Address - Fax:
Practice Address - Street 1:1140 36TH ST STE 260
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2056
Practice Address - Country:US
Practice Address - Phone:801-392-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12429831-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty