Healthcare Provider Details

I. General information

NPI: 1033596358
Provider Name (Legal Business Name): MINDY J. NIELSEN PROFESSIONAL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BETHEL RD
COLUMBUS OH
43220-2690
US

IV. Provider business mailing address

2454 SUMMIT ST
COLUMBUS OH
43202-2727
US

V. Phone/Fax

Practice location:
  • Phone: 614-595-2344
  • Fax: 614-451-3017
Mailing address:
  • Phone: 614-595-2344
  • Fax: 614-451-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC1000527-CR
License Number StateOH

VIII. Authorized Official

Name: MRS. MINDY JONELLE NIELSEN
Title or Position: PROFESSIONAL COUNSELOR-CLINICAL RES
Credential: PC-CR
Phone: 614-595-2344