Provider Demographics
NPI:1497368765
Name:NELSON, AUBREY HELENA
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:HELENA
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:
Other - Last Name:GARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20860 N TATUM BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4283
Mailing Address - Country:US
Mailing Address - Phone:866-342-8847
Mailing Address - Fax:866-342-8847
Practice Address - Street 1:20860 N TATUM BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4283
Practice Address - Country:US
Practice Address - Phone:866-342-8847
Practice Address - Fax:866-342-8847
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AZ1-24-74291103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician