MEDICARE: DR. RENEE LORIN NELSON DBH LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC-MN-147	MN
2	101YP2500X	Professional Counselor	LPC-13206	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659500759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE LORIN NELSON DBH LPC

Provider Business Mailing Address
First Line	:	4539 N 22ND ST STE 4604
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	520-636-5505
Fax Number	:	520-462-8160

Provider Business Practice Location Address
First Line	:	4539 N 22ND ST STE 4604
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	520-636-5505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	12/15/2025

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