Healthcare Provider Details

I. General information

NPI: 1760935381
Provider Name (Legal Business Name): LERRLYN NELSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17101 ALBION ST
DETROIT MI
48234-3808
US

IV. Provider business mailing address

18833 DWYER ST
DETROIT MI
48234-2607
US

V. Phone/Fax

Practice location:
  • Phone: 313-515-5380
  • Fax:
Mailing address:
  • Phone: 313-515-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number18563
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number18563
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: