Provider Demographics
NPI:1033293279
Name:NELSON, STACEY J (PHD LMFT)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7052
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33482-7052
Mailing Address - Country:US
Mailing Address - Phone:561-859-7779
Mailing Address - Fax:
Practice Address - Street 1:1200 N FEDERAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-2813
Practice Address - Country:US
Practice Address - Phone:561-859-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist