Provider Demographics
NPI:1821724584
Name:NELSON, BETTY
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 HAMILTON AVE STE 37
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5630
Mailing Address - Country:US
Mailing Address - Phone:408-766-0266
Mailing Address - Fax:
Practice Address - Street 1:1975 HAMILTON AVE STE 37
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5630
Practice Address - Country:US
Practice Address - Phone:408-766-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health