Ivan David Nelson, R-AAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

60775408 Issued in WA

Practice address

1302 Commerce Ave
Longview, WA 98632-3096

Phone

(360) 423-2806

Fax

(360) 423-5128

NPI assigned

Oct 30, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Awakenings, Inc

  • Addiction (Substance Use Disorder) Counselor
  • Kelso, WA
  • NPI 1275245722
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1033686795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 COMMERCE AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323096",
            "telephone_number": "360-423-2806",
            "fax_number": "360-423-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 COMMERCE AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323096",
            "telephone_number": "360-423-2806",
            "fax_number": "360-423-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "IVAN",
        "middle_name": "DAVID",
        "credential": "R-AAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-30",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "60775408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2155913",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raeann Nelmark, CNA
• Britaney Nelson, R-AAC, CPSST
• Caroline Nelson, PA-C
• Daniel Lee Nelson
• Diane M Nelson, NP
• Rebekah Bernice Nelson, ARNP
• Timothy E Nelson, D.D.S.
• Mia Nestaval, BA, R-AAC
• Autumn Leigh Neuenschwander, LICSW
• Lawrence H. Neville, MD

• Mental Health Counselor in Longview, WA
• Providers in Longview, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.