Provider Demographics
NPI:1124395413
Name:NUSSEN, JOY (LMFT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:NUSSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19325 ROBIN CIR APT 72
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2354
Mailing Address - Country:US
Mailing Address - Phone:949-422-6355
Mailing Address - Fax:
Practice Address - Street 1:19325 ROBIN CIR APT 72
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-2354
Practice Address - Country:US
Practice Address - Phone:949-422-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1997106H00000X
CAMFT28654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124395413OtherLMFT