Provider Demographics
NPI:1376895193
Name:NELSON, TI JANE'
Entity Type:Individual
Prefix:MS
First Name:TI
Middle Name:JANE'
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W CLEARWATER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2963
Mailing Address - Country:US
Mailing Address - Phone:509-783-7333
Mailing Address - Fax:509-783-1980
Practice Address - Street 1:2810 W CLEARWATER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2963
Practice Address - Country:US
Practice Address - Phone:509-783-7333
Practice Address - Fax:509-783-1980
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC 60287541104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker