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General NPI Number Information
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NPI Number | 1124584545
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Entity Type | Organization
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Legal Business Name | REBECCA NELSON LLC
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 3501 LAKE EASTBROOK BLVD SE STE 280
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5940
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Country | US
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Telephone | 616-202-6638
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 MARLBORO ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-4537
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Country | US
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Telephone | 616-828-8591
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | REBECCA E NELSON
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Credential | LMSW
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Telephone | 616-202-6638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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