| Doctor Name: | JONATHAN V NELSON |
| NPI Number: | 1043633407 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ISAS |
| License Number: | 10076 |
| Business Practice Address: | 233 Gooding St N Twin Falls, ID - 833016179 |
| Business Phone Number: | 2087365048 |
| Business Fax Number: | 2087352126 |
| Mailing Address: | 233 Gooding St N, TWIN FALLS |
| State: | ID |
| Postal Code: | 833016179 |
| Phone Number: | 2087365048 |
| Fax Number: | 2087352126 |
| NPI Enumeration Date: | 01/21/2014 |
| NPI Last Update Date: | 01/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 10076 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |