Doctor Name: | PETRINA NELSON |
NPI Number: | 1053508689 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | 2610 |
Business Practice Address: | 206 Sudderth Dr Ruidoso, NM - 883456001 |
Business Phone Number: | 5752575038 |
Business Fax Number: | 5755272312 |
Mailing Address: | 206 Sudderth Dr, RUIDOSO |
State: | NM |
Postal Code: | 883456001 |
Phone Number: | 5752575038 |
Fax Number: | 5755272312 |
NPI Enumeration Date: | 09/27/2007 |
NPI Last Update Date: | 04/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2610 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |