Healthcare Provider Details

I. General information

NPI: 1144183880
Provider Name (Legal Business Name): JAMIE LEE NELSON MA, LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36463 ELK AVE
NORTH BRANCH MN
55056-5579
US

IV. Provider business mailing address

36463 ELK AVE
NORTH BRANCH MN
55056-5579
US

V. Phone/Fax

Practice location:
  • Phone: 651-243-1852
  • Fax:
Mailing address:
  • Phone: 651-243-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305654
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5834
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: