Individual
CANDACE MICHELLE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
4001 E 29TH ST STE 190, BRYAN, TX 77802-4211
(979) 985-9503
Mailing address
3515 LONGMIRE DR # 256B, COLLEGE STATION, TX 77845-5489
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-16-7314
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47-3705562
GROUP TAX ID
TX
Enumeration date
07/06/2017
Last updated
07/06/2017
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