Provider Demographics
NPI:1740840727
Name:NELSON, ISRAEL JAMESDOUGLAS (D MIN, M S W)
Entity type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:JAMESDOUGLAS
Last Name:NELSON
Suffix:
Gender:M
Credentials:D MIN, M S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 E MAYFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7881
Mailing Address - Country:US
Mailing Address - Phone:907-354-2268
Mailing Address - Fax:907-357-2168
Practice Address - Street 1:5851 E MAYFLOWER CT
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7881
Practice Address - Country:US
Practice Address - Phone:907-357-6826
Practice Address - Fax:907-373-1135
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)