| Doctor Name: | MR. JUSTIN SCOTT NIELSEN |
| NPI Number: | 1124324330 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CDP, CADCII |
| License Number: | 08-08-54 |
| Business Practice Address: | 710 S.w. Rock Creek Dr. Stevenson, WA - 98648 |
| Business Phone Number: | 5094273850 |
| Business Fax Number: | |
| Mailing Address: | Po Box 790, STEVENSON |
| State: | WA |
| Postal Code: | 986480790 |
| Phone Number: | 5094273850 |
| Fax Number: | 8662972364 |
| NPI Enumeration Date: | 02/04/2011 |
| NPI Last Update Date: | 02/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 08-08-54 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |