Provider Demographics
NPI:1356487342
Name:NELSON, DENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
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 1:20845 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-7409
Mailing Address - Country:US
Mailing Address - Phone:281-689-6678
Mailing Address - Fax:
Practice Address - Street 1:1543 GREEN OAK PL
Practice Address - Street 2:STE.101
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2007
Practice Address - Country:US
Practice Address - Phone:281-852-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical