Healthcare Provider Details

I. General information

NPI: 1124648407
Provider Name (Legal Business Name): SUSAN NELSEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 EARLY ST
SANTA FE NM
87505-1607
US

IV. Provider business mailing address

118 HUDDLESON ST
SANTA FE NM
87501-1728
US

V. Phone/Fax

Practice location:
  • Phone: 505-490-0339
  • Fax:
Mailing address:
  • Phone: 505-660-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN NELSEN
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 505-660-5026