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General NPI Number Information
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NPI Number | 1396161154
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Entity Type | Individual
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Provider Name | MATTHEW NELSON MS
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Gender | Male
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 100 SILVER LAKE RD NW
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City | ST PAUL
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State | MN
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Zip | 55112
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Country | US
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Telephone | 612-271-2408
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21449
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City | MINNEAPOLIS
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State | MN
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Zip | 55421-0449
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Country | US
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Telephone | 763-560-0900
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MI0508
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3356
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License Number State | MN
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