Provider Demographics
NPI:1356468169
Name:NISSEN, JAMES CHRISTIAN (MFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHRISTIAN
Last Name:NISSEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 CRONWELL DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0821
Mailing Address - Country:US
Mailing Address - Phone:408-371-2711
Mailing Address - Fax:
Practice Address - Street 1:3033 MOORPARK AVE
Practice Address - Street 2:SUITE #8
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2521
Practice Address - Country:US
Practice Address - Phone:408-247-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 19060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist