Provider Demographics
NPI:1831821883
Name:NELSON, ERIK DAVID
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:DAVID
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 18TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2202
Mailing Address - Country:US
Mailing Address - Phone:971-222-8720
Mailing Address - Fax:
Practice Address - Street 1:22232 17TH AVE SE STE 302
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7425
Practice Address - Country:US
Practice Address - Phone:425-487-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist