Provider Demographics
NPI:1164551933
Name:NELSON, SCOTT LESTER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LESTER
Last Name:NELSON
Suffix:
Gender:M
Credentials:PSYD
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 27264
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-7264
Mailing Address - Country:US
Mailing Address - Phone:714-381-0836
Mailing Address - Fax:
Practice Address - Street 1:3300 IRVINE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3109
Practice Address - Country:US
Practice Address - Phone:949-229-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27994103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical