Provider Demographics
NPI:1023176146
Name:NELSON, DOUGLAS BRINKLEY (LMHC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BRINKLEY
Last Name:NELSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:954-789-9061
Mailing Address - Fax:
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 221
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-789-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001944101YP2500X
FLMH11689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional