Provider Demographics
NPI:1376274613
Name:NELSON, HEATHER LEA (QMHP-R, CADC-R)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEA
Last Name:NELSON
Suffix:
Gender:F
Credentials:QMHP-R, CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10564 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2809
Mailing Address - Country:US
Mailing Address - Phone:971-806-0571
Mailing Address - Fax:503-228-9558
Practice Address - Street 1:10564 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2809
Practice Address - Country:US
Practice Address - Phone:971-806-0571
Practice Address - Fax:503-228-9558
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health