Healthcare Provider Details

I. General information

NPI: 1518927920
Provider Name (Legal Business Name): NELSON BEHAVIORAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CENTER ST
RIDGWAY PA
15853-1716
US

IV. Provider business mailing address

102 CENTER ST
RIDGWAY PA
15853-1716
US

V. Phone/Fax

Practice location:
  • Phone: 814-772-5546
  • Fax: 814-772-0511
Mailing address:
  • Phone: 814-772-5546
  • Fax: 814-772-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS015091
License Number StatePA

VIII. Authorized Official

Name: DR. BRUCE ROLAND SIMONS
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 814-772-5546