Individual
JACQUELYN NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.C
Contact information
Practice address
1845 S DOBSON RD, SUITE 207, MESA, AZ 85202-5661
(480) 316-5462
Mailing address
202 N 9TH ST STE 401C, BOISE, ID 83702-5770
(480) 316-5462
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LCPC-7532
ID
101YP2500X
Professional Counselor
Primary
LPC-16033
AZ
Other
Enumeration date
02/13/2017
Last updated
01/30/2020
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