| Doctor Name: | MR. JARED PORTER NESLEN |
| NPI Number: | 1003159278 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED. |
| License Number: | 7433037-6004 |
| Business Practice Address: | 172 Thomas Johnson Dr Ste 200 Frederick, MD - 217024402 |
| Business Phone Number: | 3016945896 |
| Business Fax Number: | |
| Mailing Address: | 172 Thomas Johnson Dr, Ste 200 FREDERICK |
| State: | MD |
| Postal Code: | 217024402 |
| Phone Number: | 3017081860 |
| Fax Number: | |
| NPI Enumeration Date: | 04/05/2013 |
| NPI Last Update Date: | 05/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 7433037-6004 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |