Individual
JACOB SAMUEL NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHT
Contact information
Practice address
15214 N CAVE CREEK RD STE A, PHOENIX, AZ 85032-4360
(888) 973-2090
Mailing address
5707 N 44TH LN STE B, GLENDALE, AZ 85301-6307
(800) 501-4732
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AZ
175T00000X
Peer Specialist
—
AZ
Other
Enumeration date
10/18/2021
Last updated
05/31/2023
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