Provider Demographics
NPI:1376736926
Name:NILSEN, JEFFREY MARTIN (AOD COUNSELOR)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARTIN
Last Name:NILSEN
Suffix:
Gender:M
Credentials:AOD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 TOWNSEND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1697
Mailing Address - Country:US
Mailing Address - Phone:415-905-5555
Mailing Address - Fax:
Practice Address - Street 1:350 TOWNSEND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1697
Practice Address - Country:US
Practice Address - Phone:415-905-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)