Provider Demographics
NPI:1700191517
Name:NELSON, KJERESTI (LMFT)
Entity Type:Individual
Prefix:
First Name:KJERESTI
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KJERSTI
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:19 S B ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3995
Mailing Address - Country:US
Mailing Address - Phone:650-416-6388
Mailing Address - Fax:
Practice Address - Street 1:19 S B ST STE 3
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3995
Practice Address - Country:US
Practice Address - Phone:650-416-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health