Healthcare Provider Details

I. General information

NPI: 1043644792
Provider Name (Legal Business Name): BARBARA JEAN NELSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 28TH AVE SW
WILLMAR MN
56201-5241
US

IV. Provider business mailing address

2105 COUNTRY CLUB DR NE
WILLMAR MN
56201-2186
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-8558
  • Fax: 320-235-2733
Mailing address:
  • Phone: 320-235-2950
  • Fax: 320-235-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2546
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: