Provider Demographics
NPI:1225246440
Name:NELSON, ELIZABETH JO (ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JO
Last Name:NELSON
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JO
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8635 N GLOUCESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5937
Mailing Address - Country:US
Mailing Address - Phone:971-998-5584
Mailing Address - Fax:
Practice Address - Street 1:8635 N GLOUCESTER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5937
Practice Address - Country:US
Practice Address - Phone:971-998-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health