Healthcare Provider Details

I. General information

NPI: 1255246948
Provider Name (Legal Business Name): MERCEDES ANTIONETTE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 TEXAS PLAZA DR APT 3101
IRVING TX
75062-4859
US

IV. Provider business mailing address

2031 TEXAS PLAZA DR APT 3101
IRVING TX
75062-4859
US

V. Phone/Fax

Practice location:
  • Phone: 601-334-8186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: