Active NPI
Camm Nelsen
- Marriage & Family Therapist
- Santa Cruz, CA
National Provider Identifier
1336679885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- AMFT144820
- Practice address
- 200 7TH Avenue. Suite 150
Santa Cruz, CA 95062 - Phone
- (831) 462-1060
- Fax
- (831) 462-4970
- NPI assigned
- Jun 18, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | R1243250217 | CA | |
| Marriage & Family Therapist | 106H00000X | AMFT144820 | CA | Primary |
Addresses
Primary practice location
200 7TH Avenue. Suite 150
Santa Cruz, CA 95062
Mailing address
200 7TH Avenue. Suite 150
Santa Cruz, CA 95062
Phone (831) 462-1060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AMFT144820 | Other | CA | AMFT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1243250217 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| AMFT144820 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713139200000",
"number": "1336679885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 7TH AVENUE. SUITE 150",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "95062",
"telephone_number": "831-462-1060",
"fax_number": "831-462-4970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 7TH AVENUE. SUITE 150",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "95062",
"telephone_number": "831-462-1060",
"fax_number": "831-462-4970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSEN",
"first_name": "CAMM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-18",
"last_updated": "2024-04-15",
"certification_date": "2024-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "R1243250217",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "AMFT144820",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMFT",
"identifier": "AMFT144820",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.