Provider Demographics
NPI:1902187206
Name:NESTOR, JON O (MDIV, MED, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:O
Last Name:NESTOR
Suffix:
Gender:M
Credentials:MDIV, MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 N COAST HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2357
Mailing Address - Country:US
Mailing Address - Phone:541-574-7856
Mailing Address - Fax:541-547-3568
Practice Address - Street 1:1636 N COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2357
Practice Address - Country:US
Practice Address - Phone:541-574-7856
Practice Address - Fax:541-547-3568
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1511101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC1511OtherOREGON BOARD OF PROFESSIONAL THERAPISTS AND COUNSELORS
OR4131OtherAMERICAN ASSOCIATION OF PASTORAL COUNSELORS