Provider Demographics
NPI:1184182024
Name:NELSON, AMBER KHYRA JAMISEN (LMHC, ATR, EMDR)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KHYRA JAMISEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMHC, ATR, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 RENAISSANCE BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5689
Mailing Address - Country:US
Mailing Address - Phone:850-766-2628
Mailing Address - Fax:
Practice Address - Street 1:2123 RENAISSANCE BLVD APT 208
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5689
Practice Address - Country:US
Practice Address - Phone:850-766-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15792101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health