Healthcare Provider Details

I. General information

NPI: 1386662369
Provider Name (Legal Business Name): ANDREA NELSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W OJAI AVE SUITE 206
OJAI CA
93023-2472
US

IV. Provider business mailing address

530 W OJAI AVE SUITE 206
OJAI CA
93023-2472
US

V. Phone/Fax

Practice location:
  • Phone: 805-640-8549
  • Fax: 805-640-8624
Mailing address:
  • Phone: 805-640-8549
  • Fax: 805-640-8624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: