Provider Demographics
NPI:1356674956
Name:NELSON, ERIC DAVID (MA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DAVID
Last Name:NELSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 N OAK KNOLL AVE
Mailing Address - Street 2:APT. 107
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4101
Mailing Address - Country:US
Mailing Address - Phone:805-835-5389
Mailing Address - Fax:
Practice Address - Street 1:2555 E COLORADO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6622
Practice Address - Country:US
Practice Address - Phone:626-577-2261
Practice Address - Fax:626-577-2543
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN868OtherLA COUNTY DMH