Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 5072 | OH |
N | 103T00000X | Psychologist | 5072 | OH |
Y | 103G00000X | Clinical Psychologist | 5072 | OH |
Y | 103TC0700X | Clinical Psychologist | 5072 | OH |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 5072 | OH |
N | 103TP2701X | Group Psychotherapist | 5072 | OH |
NPI | 1124169255 |
---|---|
Provider Name | Dr. Patrick R. Nelson |
First Address | Oxford, OH 45056-0136 |
Second Address | Oxford, OH 45056-1747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2007 |
Last Update Date | 08/01/2015 |