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General NPI Number Information
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NPI Number | 1548814189
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Entity Type | Organization
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Legal Business Name | NELSON PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 07/31/2019
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 8360 W OAKLAND PARK BLVD STE 301F&G
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City | SUNRISE
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State | FL
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Zip | 33351-7332
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Country | US
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Telephone | 941-404-5483
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Fax | 941-328-3575
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Provider Business Mailing Address
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Address Line | 8360 W OAKLAND PARK BLVD STE 301F&G
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City | SUNRISE
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State | FL
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Zip | 33351-7332
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Country | US
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Telephone | 941-404-5483
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Fax | 941-328-3575
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Authorized Official
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Title or Position | CEO
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Name | TIESHA S NELSON
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Credential | PSY.D.
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Telephone | 954-294-8139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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