Healthcare Provider Details

I. General information

NPI: 1194393223
Provider Name (Legal Business Name): BRITTANY LEE NELSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S 4TH ST
OREGON IL
61061-1628
US

IV. Provider business mailing address

121 S 4TH ST
OREGON IL
61061-1628
US

V. Phone/Fax

Practice location:
  • Phone: 815-732-2499
  • Fax:
Mailing address:
  • Phone: 815-501-2088
  • Fax: 815-562-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.023129
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number149.023129
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: