Provider Demographics
NPI:1497818355
Name:NIELSEN, DEBORAH JEAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12016 BARTLETT AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5837
Mailing Address - Country:US
Mailing Address - Phone:760-937-5361
Mailing Address - Fax:
Practice Address - Street 1:100 DENNY WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4049
Practice Address - Country:US
Practice Address - Phone:206-888-4894
Practice Address - Fax:206-339-1499
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61400079101YM0800X
CAMFC32618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659433191OtherTIHP NPI
CAFHC11576FMedicaid
CATHP11576FMedicaid
CAFHC11576FMedicaid
CAZZZ85276ZMedicare ID - Type UnspecifiedLOCAL MEDICARE GROUP #