Healthcare Provider Details

I. General information

NPI: 1487767380
Provider Name (Legal Business Name): ALISA K NELSON LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20956 MACK AVE
GROSSE POINTE WOODS MI
48236-1355
US

IV. Provider business mailing address

20956 MACK AVE
GROSSE POINTE WOODS MI
48236-1355
US

V. Phone/Fax

Practice location:
  • Phone: 586-457-0286
  • Fax:
Mailing address:
  • Phone: 586-457-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361005321
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: