Provider Demographics
NPI:1952773137
Name:NIELSEN, DANE (MA, LMHC, LPC, CADC)
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MA, LMHC, LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 164TH AVE NE STE I145
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7848
Mailing Address - Country:US
Mailing Address - Phone:503-765-6209
Mailing Address - Fax:
Practice Address - Street 1:5400 SAINT CHARLES LOOP NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-9588
Practice Address - Country:US
Practice Address - Phone:503-765-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-10-11101YA0400X
ORC5602101YM0800X
WALH61292084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)