Healthcare Provider Details

I. General information

NPI: 1225480775
Provider Name (Legal Business Name): MS. TASHA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CARTER DR
MONROE LA
71203
US

IV. Provider business mailing address

107 CARTER DR
MONROE LA
71203-6806
US

V. Phone/Fax

Practice location:
  • Phone: 318-614-2315
  • Fax:
Mailing address:
  • Phone: 318-614-2315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4206
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: