Healthcare Provider Details

I. General information

NPI: 1225950207
Provider Name (Legal Business Name): KELLIE JANE NIELSEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N LAWLER ST STE 6
MITCHELL SD
57301-2635
US

IV. Provider business mailing address

713 E 15TH AVE
MITCHELL SD
57301-1515
US

V. Phone/Fax

Practice location:
  • Phone: 605-501-6681
  • Fax:
Mailing address:
  • Phone: 605-501-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC20942
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: