Provider Demographics
NPI:1801091319
Name:NELSON, BARBARA ELIZABETH (MFT)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SANTA ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2049
Mailing Address - Country:US
Mailing Address - Phone:415-332-4194
Mailing Address - Fax:
Practice Address - Street 1:10 WILLOW ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2845
Practice Address - Country:US
Practice Address - Phone:415-332-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist