Provider Demographics
NPI:1700995982
Name:NELSON, LONNIE A (PHD)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 E PIMA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3663
Mailing Address - Country:US
Mailing Address - Phone:520-323-0062
Mailing Address - Fax:520-323-1336
Practice Address - Street 1:5363 E PIMA ST
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3663
Practice Address - Country:US
Practice Address - Phone:520-323-0062
Practice Address - Fax:520-323-1336
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3767103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist