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General NPI Number Information
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NPI Number | 1396173555
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Entity Type | Individual
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Provider Name | MRS. JENNIFER NIELSON
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Gender | Female
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Dates
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Enumeration Date | 10/28/2013
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 1711 MELLOR DR
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City | LAKEPORT
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State | CA
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Zip | 95453-3413
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Country | US
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Telephone | 707-245-9472
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Fax | 707-279-8564
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Provider Business Mailing Address
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Address Line | 1711 MELLOR DR
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City | LAKEPORT
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State | CA
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Zip | 95453-3413
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Country | US
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Telephone | 707-263-8795
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Fax | 707-263-6561
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 105816
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License Number State | CA
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