Provider Demographics
NPI:1235603796
Name:NELSON, LYNDSEY (LMFT)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
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 1:200 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4639
Mailing Address - Country:US
Mailing Address - Phone:650-787-3278
Mailing Address - Fax:
Practice Address - Street 1:1225 CRANE ST STE 106B
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4253
Practice Address - Country:US
Practice Address - Phone:650-240-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113189106H00000X
CA75560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist