Provider Demographics
NPI:1164739405
Name:STEVENS-NELSON, GAELEN ELIZABETH
Entity Type:Individual
Prefix:
First Name:GAELEN
Middle Name:ELIZABETH
Last Name:STEVENS-NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2205
Mailing Address - Country:US
Mailing Address - Phone:510-531-3111
Mailing Address - Fax:
Practice Address - Street 1:2550 23RD ST
Practice Address - Street 2:BUILDING 9, ROOM 130
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3504
Practice Address - Country:US
Practice Address - Phone:415-206-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA74642.106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health