MEDICARE: DR. JAMES A NELSON PHD., LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	519	MN

General Provider Information

NPI Number	:	1003964891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A NELSON PHD., LMFT

Provider Business Mailing Address
First Line	:	227 COLFAX AVE N
Second Line	:	SUITE 130
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-1419
Country	:	US
Telephone Number	:	612-759-8789
Fax Number	:	612-823-3869

Provider Business Practice Location Address
First Line	:	227 COLFAX AVE N
Second Line	:	SUITE 130
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-1419
Country	:	US
Telephone Number	:	612-759-8789
Fax Number	:	612-823-3869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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