MEDICARE: JANET ANGEL 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CATC-I #7154-I	CA
2	106H00000X	Marriage & Family Therapist	LMFT112967	CA

General Provider Information

NPI Number	:	1851757322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET ANGEL NELSON LMFT

Provider Business Mailing Address
First Line	:	200 N WALNUT ST # 276
Second Line	:
City	:	BUFFALO GAP
State	:	SD
Zip	:	57722-9998
Country	:	US
Telephone Number	:	858-663-2170
Fax Number	:	605-833-2010

Provider Business Practice Location Address
First Line	:	200 N WALNUT ST # 276
Second Line	:
City	:	BUFFALO GAP
State	:	SD
Zip	:	57722-9998
Country	:	US
Telephone Number	:	858-663-2170
Fax Number	:	605-833-2010

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

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	10/28/2024

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