Healthcare Provider Details

I. General information

NPI: 1497276216
Provider Name (Legal Business Name): JOEL NIELSON LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CLEVELAND BLVD STE 180
CALDWELL ID
83605-4076
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-912-0892
  • Fax: 208-345-3502
Mailing address:
  • Phone: 208-467-4431
  • Fax: 208-466-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCPC-9039
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: