Doctor Name: | TREVOR JAMES NELSON |
NPI Number: | 1174971014 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMSW |
License Number: | LMSW-35746 |
Business Practice Address: | 393 E 2nd N Rexburg, ID - 834401605 |
Business Phone Number: | 2083594840 |
Business Fax Number: | 2083599010 |
Mailing Address: | 393 E 2nd N, REXBURG |
State: | ID |
Postal Code: | 834401605 |
Phone Number: | 2083594840 |
Fax Number: | 2083599010 |
NPI Enumeration Date: | 06/01/2016 |
NPI Last Update Date: | 06/01/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LMSW-35746 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |