Provider Demographics
NPI:1275837858
Name:NELSON, DAVID V (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHOLOGY & PHILOSOPHY
Mailing Address - Street 2:SHSU BOX 2447
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77341-2447
Mailing Address - Country:US
Mailing Address - Phone:936-294-4709
Mailing Address - Fax:936-294-3798
Practice Address - Street 1:919 BEARKAT BLVD
Practice Address - Street 2:PSYCHOLOGICAL SERVICES CENTER
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-294-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23271103T00000X, 103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth