MEDICARE: MR. JUSTIN NELSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1417367194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN NELSON

Provider Business Mailing Address
First Line	:	3932 YELLOW MANDARIN AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-4018
Country	:	US
Telephone Number	:	702-561-1724
Fax Number	:

Provider Business Practice Location Address
First Line	:	3932 YELLOW MANDARIN AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-4018
Country	:	US
Telephone Number	:	702-561-1724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	05/02/2014

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Directions to “ MR. JUSTIN NELSON ” Practice Location

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