MEDICARE: MELANIE C NELSON LCSW

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	1041C0700X	Clinical Social Worker	110029	TX
2	1041C0700X	Clinical Social Worker	LCSW107320	CA

General Provider Information

NPI Number	:	1740996693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE C NELSON LCSW

Provider Business Mailing Address
First Line	:	1600 STOUT ST STE 2000
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-3113
Country	:	US
Telephone Number	:	720-204-5760
Fax Number	:

Provider Business Practice Location Address
First Line	:	12966 EUCLID ST STE 110
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-9203
Country	:	US
Telephone Number	:	720-204-5760
Fax Number	:

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

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	03/30/2023

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