Provider Demographics
NPI:1891176921
Name:NEILSON, JENNIFER (MA, LPCC, NCC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:NEILSON
Suffix:
Gender:F
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 HIGHLANDER DR
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-6230
Mailing Address - Country:US
Mailing Address - Phone:619-944-9664
Mailing Address - Fax:
Practice Address - Street 1:2100 GARDEN RD STE F-3
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5366
Practice Address - Country:US
Practice Address - Phone:831-204-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC4998101YP2500X
171M00000X
CAPCCI2435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty