Provider Demographics
NPI:1821431198
Name:NELSON, MARSHA (PH D, MH COUNSELOR)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:PH D, MH COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SE BAUBLITS DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-3102
Mailing Address - Country:US
Mailing Address - Phone:850-332-0992
Mailing Address - Fax:
Practice Address - Street 1:235 SE BAUBLITS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-3102
Practice Address - Country:US
Practice Address - Phone:850-332-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80723101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional