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General NPI Number Information
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NPI Number | 1710601067
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Entity Type | Organization
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Legal Business Name | TM NELSON: COUNSELING & WELLNESS, LLC
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 4801 W PETERSON AVE STE 305
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City | CHICAGO
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State | IL
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Zip | 60646-5726
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Country | US
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Telephone | 312-576-0127
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 W FARWELL AVE APT 3S
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City | CHICAGO
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State | IL
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Zip | 60626-3657
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Country | US
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Telephone | 312-576-0127
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Fax |
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Authorized Official
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Title or Position | THERAPIST/SOCIAL WORKER
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Name | TODD M NELSON
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Credential | LCSW
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Telephone | 312-576-0127
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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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