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General NPI Number Information
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NPI Number | 1083579148
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Entity Type | Individual
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Provider Name | STACY NELSON
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Gender | Female
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 152 E 6TH ST STE 116
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City | FREMONT
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State | NE
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Zip | 68025-5092
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Country | US
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Telephone | 402-720-1741
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Fax | 402-769-4005
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Provider Business Mailing Address
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Address Line | 6863 COUNTY ROAD 11
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City | ARLINGTON
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State | NE
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Zip | 68002-5167
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Country | US
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Telephone | 402-670-7491
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Fax | 402-769-4005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 14701
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License Number State | NE
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