Provider Demographics
NPI:1710489695
Name:JIM, NELSON (LMFT)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:JIM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MINNESOTA ST APT 153
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3063
Mailing Address - Country:US
Mailing Address - Phone:415-641-6017
Mailing Address - Fax:
Practice Address - Street 1:56 JULIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3507
Practice Address - Country:US
Practice Address - Phone:415-864-0964
Practice Address - Fax:415-864-5428
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist