Provider Demographics
NPI:1235316811
Name:NELSON, JILL (BA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 OLAN MILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1891
Mailing Address - Country:US
Mailing Address - Phone:423-296-4224
Mailing Address - Fax:423-296-4230
Practice Address - Street 1:2229 OLAN MILLS DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1891
Practice Address - Country:US
Practice Address - Phone:423-296-4224
Practice Address - Fax:423-296-4230
Is Sole Proprietor?:No
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities