Provider Demographics
NPI:1265394837
Name:NELSON, HAVEN NICHOLE
Entity type:Individual
Prefix:
First Name:HAVEN
Middle Name:NICHOLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N DOWNING ST APT 301
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2956
Mailing Address - Country:US
Mailing Address - Phone:720-666-9152
Mailing Address - Fax:
Practice Address - Street 1:6700 E SPEEDWAY BLVD STE 401
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1220
Practice Address - Country:US
Practice Address - Phone:520-448-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO232318655215106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician