Provider Demographics
NPI:1972725851
Name:NELSON, AUDRE ELIZABETH (MA LMFT)
Entity Type:Individual
Prefix:
First Name:AUDRE
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9057B SOQUEL DR STE B
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4044
Mailing Address - Country:US
Mailing Address - Phone:831-420-2040
Mailing Address - Fax:831-462-9956
Practice Address - Street 1:9057B SOQUEL DR STE B
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-420-2040
Practice Address - Fax:831-462-9956
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT48446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist