Healthcare Provider Details

I. General information

NPI: 1427384379
Provider Name (Legal Business Name): SCOTT NIELSEN MA, CPRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 ARROWHEAD LN
MOOSE LAKE MN
55767-8201
US

IV. Provider business mailing address

451 ARROWHEAD LN
MOOSE LAKE MN
55767-8201
US

V. Phone/Fax

Practice location:
  • Phone: 218-485-4445
  • Fax:
Mailing address:
  • Phone: 218-485-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC05520
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: