Healthcare Provider Details

I. General information

NPI: 1467317628
Provider Name (Legal Business Name): KAREN GAINER NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S 11TH ST
SAN JOSE CA
95112-2132
US

IV. Provider business mailing address

3821 EASTWOOD CIR
SANTA CLARA CA
95054-2125
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-5191
  • Fax:
Mailing address:
  • Phone: 504-314-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1541430124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: