Provider Demographics
NPI:1497119325
Name:NELSON, BRIAN (CADC-00329-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:CADC-00329-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 JASON CT
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-8296
Mailing Address - Country:US
Mailing Address - Phone:775-304-0757
Mailing Address - Fax:
Practice Address - Street 1:35 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3137
Practice Address - Country:US
Practice Address - Phone:775-304-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCADC--00329-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)