Provider Demographics
NPI:1144724881
Name:NELSON PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:NELSON PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINAL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:484-516-8142
Mailing Address - Street 1:183 VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-9727
Mailing Address - Country:US
Mailing Address - Phone:484-516-8142
Mailing Address - Fax:
Practice Address - Street 1:220 W GAY ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2917
Practice Address - Country:US
Practice Address - Phone:484-516-8142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty