NELSON PSYCHOLOGICAL SERVICES, LLC

Provider Demographics

• NPI: 1548814189
• Name: NELSON PSYCHOLOGICAL SERVICES, LLC
• Entity type: Organization
• Organization Name: NELSON PSYCHOLOGICAL SERVICES, LLC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: TIESHA
• Authorized Official - Middle Name: S
• Authorized Official - Last Name: NELSON
• Authorized Official - Credentials: PSYD
• Authorized Official - Phone: 954-294-8139
• Mailing Address - Street 1: 8360 W OAKLAND PARK BLVD STE 301F&G
• Mailing Address - City: SUNRISE
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33351-7332
• Mailing Address - Country: US
• Mailing Address - Phone: 941-404-5483
• Mailing Address - Fax: 941-328-3575
• Practice Address - Street 1: 8360 W OAKLAND PARK BLVD STE 301F&G
• Practice Address - City: SUNRISE
• Practice Address - State: FL
• Practice Address - Zip Code: 33351-7332
• Practice Address - Country: US
• Practice Address - Phone: 941-404-5483
• Practice Address - Fax: 941-328-3575
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2019-07-31
• Last Update Date: 2020-06-15

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	251S00000X	Agencies	Community/Behavioral Health
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	171M00000X	Other Service Providers	Case Manager/Care Coordinator		Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health
No	261QM0855X	Ambulatory Health Care Facilities	Clinic/Center	Adolescent and Children Mental Health	Group - Multi-Specialty