=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326815200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN LEE NELSON PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2023
-----------------------------------------------------
Last Update Date | 09/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1169 GRAND CENTRAL PKWY
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-3185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-525-3600
-----------------------------------------------------
Fax | 936-525-3624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 925 CITY CENTRAL AVE
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-2981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-202-5279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 32522
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------