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General NPI Number Information
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NPI Number | 1104064021
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Entity Type | Organization
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Legal Business Name | BETH NELSON LLC
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 2200 21ST AVE S SUITE 251
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City | NASHVILLE
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State | TN
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Zip | 37212-4942
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Country | US
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Telephone | 615-545-9423
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 90029
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City | NASHVILLE
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State | TN
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Zip | 37209-0029
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Country | US
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Telephone | 615-545-9423
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY BETH NELSON
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Credential | LPC, MHSP
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Telephone | 615-545-9423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC0000002341
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License Number State | TN
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