Provider Demographics
NPI:1851757322
Name:NELSON, JANET ANGEL (LMFT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ANGEL
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N WALNUT ST # 276
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GAP
Mailing Address - State:SD
Mailing Address - Zip Code:57722-9998
Mailing Address - Country:US
Mailing Address - Phone:858-663-2170
Mailing Address - Fax:605-833-2010
Practice Address - Street 1:200 N WALNUT ST # 276
Practice Address - Street 2:
Practice Address - City:BUFFALO GAP
Practice Address - State:SD
Practice Address - Zip Code:57722-9998
Practice Address - Country:US
Practice Address - Phone:858-663-2170
Practice Address - Fax:605-833-2010
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACATC-I #7154-I101YA0400X
CALMFT112967106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)