Provider Demographics
NPI:1861937120
Name:NELSON, JOSH WYATT (CADC-II)
Entity type:Individual
Prefix:MR
First Name:JOSH
Middle Name:WYATT
Last Name:NELSON
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 MORRO RD STE D
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4142
Mailing Address - Country:US
Mailing Address - Phone:805-461-5212
Mailing Address - Fax:805-461-5873
Practice Address - Street 1:6500 MORRO RD STE D
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4142
Practice Address - Country:US
Practice Address - Phone:805-461-5212
Practice Address - Fax:805-461-5873
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051180519101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3302967OtherWE ARE AN ALCOHOL AND DRUG SERVICE THAT ACCEPTS MEDICAL