Provider Demographics
NPI:1588954044
Name:NELSON, PAUL JOHN JR (RBT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOHN
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:RBT
Other - Prefix:
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Mailing Address - Street 1:2626 SW IMPALA WAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-1233
Mailing Address - Country:US
Mailing Address - Phone:772-285-2532
Mailing Address - Fax:
Practice Address - Street 1:1887 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5530
Practice Address - Country:US
Practice Address - Phone:772-463-0444
Practice Address - Fax:772-219-1339
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2024-04-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician