Provider Demographics
NPI:1659501013
Name:NELSON, ROBERT L JR (CACIII)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ACOMA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1429
Mailing Address - Country:US
Mailing Address - Phone:303-722-5746
Mailing Address - Fax:303-777-7601
Practice Address - Street 1:107 ACOMA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1429
Practice Address - Country:US
Practice Address - Phone:303-722-5746
Practice Address - Fax:303-777-7601
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4054101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)