Provider Demographics
NPI:1336332337
Name:NELSON, MARINA ISABELLA (MC, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:ISABELLA
Last Name:NELSON
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:10200 SW EASTRIDGE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5031
Mailing Address - Country:US
Mailing Address - Phone:503-201-7502
Mailing Address - Fax:503-292-2980
Practice Address - Street 1:10200 SW EASTRIDGE ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5031
Practice Address - Country:US
Practice Address - Phone:503-201-7502
Practice Address - Fax:503-292-2980
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC11117101YM0800X
ORC1934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health