Provider Demographics
NPI:1407306764
Name:NELSON, KRISTI
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
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 1:105 PASEO DEL CANON W
Mailing Address - Street 2:STE A
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6943
Mailing Address - Country:US
Mailing Address - Phone:575-758-5857
Mailing Address - Fax:575-758-5860
Practice Address - Street 1:105 PASEO DEL CANON W
Practice Address - Street 2:STE A
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6943
Practice Address - Country:US
Practice Address - Phone:575-758-5857
Practice Address - Fax:575-758-5860
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD0215941101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health