Provider Demographics
NPI:1396023982
Name:NIELSEN, BROOKE MICHELLE (MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:MICHELLE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 CHATSWORTH BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2740
Mailing Address - Country:US
Mailing Address - Phone:858-876-5043
Mailing Address - Fax:
Practice Address - Street 1:312 S. CEDROS AVE. STE 334
Practice Address - Street 2:STE. 304
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92107
Practice Address - Country:US
Practice Address - Phone:858-876-5043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist