Healthcare Provider Details

I. General information

NPI: 1396365979
Provider Name (Legal Business Name): MISTY NELSON M.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 TIPTON SPRINGS RD
MORGANTON GA
30560-4456
US

IV. Provider business mailing address

962 TIPTON SPRINGS RD
MORGANTON GA
30560-4456
US

V. Phone/Fax

Practice location:
  • Phone: 706-633-7588
  • Fax:
Mailing address:
  • Phone: 706-633-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-55058
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-116164
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: