Provider Demographics
NPI:1356717979
Name:NELSON, RACHELLE (PSYD)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 AIRPORT RD
Mailing Address - Street 2:STE D
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2823
Mailing Address - Country:US
Mailing Address - Phone:850-424-5210
Mailing Address - Fax:850-424-3220
Practice Address - Street 1:1008 AIRPORT RD
Practice Address - Street 2:STE D
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2823
Practice Address - Country:US
Practice Address - Phone:850-424-5210
Practice Address - Fax:850-424-3220
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9352103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical