MEDICARE: MS. ANNE-KARIN NELSON LMFT

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	101YM0800X	Mental Health Counselor	97367	CA
2	225100000X	Physical Therapist	8932	CA

General Provider Information

NPI Number	:	1710259114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE-KARIN NELSON LMFT

Provider Business Mailing Address
First Line	:	1812 W 25TH ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90732-4202
Country	:	US
Telephone Number	:	310-702-3154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 S ELENA AVE STE 205
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5717
Country	:	US
Telephone Number	:	310-940-3709
Fax Number	:

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

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	03/04/2024

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