Provider Demographics
NPI:1386662369
Name:NELSON, ANDREA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W OJAI AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2472
Mailing Address - Country:US
Mailing Address - Phone:805-640-8549
Mailing Address - Fax:805-640-8624
Practice Address - Street 1:530 W OJAI AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2472
Practice Address - Country:US
Practice Address - Phone:805-640-8549
Practice Address - Fax:805-640-8624
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00CP13378Medicaid
CA00CP13378Medicaid
CACP13378Medicare PIN