Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003116484 |
---|---|
Provider Name | Nick Nelson |
First Address | Bridgeport, CT 06604-2355 |
Second Address | Danbury, CT 06810-6528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2010 |
Last Update Date | 14/07/2016 |