Healthcare Provider Details

I. General information

NPI: 1659500759
Provider Name (Legal Business Name): RENEE LORIN NELSON DBH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI RENEE BITTER

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE 4604
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST STE 4604
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 520-636-5505
  • Fax:
Mailing address:
  • Phone: 520-636-5505
  • Fax: 520-462-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-MN-147
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13206
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: