Provider Demographics
NPI:1215220231
Name:NELSON, ANNMARIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANNMARIE
Middle Name:
Last Name:NELSON
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 1:27201 PUERTA REAL SUITE 300
Mailing Address - Street 2:PMB 305
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-445-0510
Mailing Address - Fax:
Practice Address - Street 1:27201 PUERTA REAL SUITE 300
Practice Address - Street 2:PMB 305
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-445-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166001530106H00000X
NY002043106H00000X
TX204123106H00000X
CALMFT97177106H00000X
CA97177106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist