Healthcare Provider Details

I. General information

NPI: 1629061221
Provider Name (Legal Business Name): CONNIE LEE NELSON MA QMHP LPCMH CCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 W TECHNOLOGY CIR
SIOUX FALLS SD
57106-4233
US

IV. Provider business mailing address

3803 W TECHNOLOGY CIR
SIOUX FALLS SD
57106-4233
US

V. Phone/Fax

Practice location:
  • Phone: 605-702-4409
  • Fax: 605-309-7914
Mailing address:
  • Phone: 605-702-4409
  • Fax: 605-309-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCMH2116
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberICADC2245
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number45265
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9605696
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: