Provider Demographics
NPI:1558156638
Name:NELSON, LAURA LEE (AMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 STORY PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3046
Mailing Address - Country:US
Mailing Address - Phone:323-447-2784
Mailing Address - Fax:
Practice Address - Street 1:230 N MARYLAND AVE STE 303
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4281
Practice Address - Country:US
Practice Address - Phone:747-273-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT151480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty