Provider Demographics
NPI:1346678380
Name:NELSON, ALICE (LMFT)
Entity Type:Individual
Prefix:
First Name:ALICE
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 1:113 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3519
Mailing Address - Country:US
Mailing Address - Phone:503-263-8903
Mailing Address - Fax:
Practice Address - Street 1:113 N ELM ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3519
Practice Address - Country:US
Practice Address - Phone:503-657-8903
Practice Address - Fax:503-650-4302
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT1234OtherLICENSED MARRIAGE AND FAMILY THERAPIST