Provider Demographics
NPI:1477625432
Name:NELSON, NICOLE WINDHURST (MFT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:WINDHURST
Last Name:NELSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:WINDHURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6321
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-0321
Mailing Address - Country:US
Mailing Address - Phone:415-457-3200
Mailing Address - Fax:
Practice Address - Street 1:734 A ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3923
Practice Address - Country:US
Practice Address - Phone:415-482-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45682106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist