Provider Demographics
NPI:1477182913
Name:NELSON, ELIZABETH PAGE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PAGE
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 1:440 MCKAY PL
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2945
Mailing Address - Country:US
Mailing Address - Phone:443-739-7706
Mailing Address - Fax:
Practice Address - Street 1:440 MCKAY PL
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2945
Practice Address - Country:US
Practice Address - Phone:443-739-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13992076-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist