Provider Demographics
NPI:1972720951
Name:NELSON, VERNA L (MFT)
Entity type:Individual
Prefix:
First Name:VERNA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POLLARD RD STE B207
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1429
Mailing Address - Country:US
Mailing Address - Phone:408-379-7747
Mailing Address - Fax:408-379-3741
Practice Address - Street 1:800 POLLARD RD STE B207
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1429
Practice Address - Country:US
Practice Address - Phone:408-379-7747
Practice Address - Fax:408-379-3741
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#42077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist