Healthcare Provider Details

I. General information

NPI: 1730719683
Provider Name (Legal Business Name): ALEXANDRIA MARIE NELSON LPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRIA MARIE WEEDEN

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W 519 UNIT A
PRYOR OK
74361-9502
US

IV. Provider business mailing address

2900 W 519 UNIT A
PRYOR OK
74361-9502
US

V. Phone/Fax

Practice location:
  • Phone: 603-660-7852
  • Fax:
Mailing address:
  • Phone: 603-660-7852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: