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General NPI Number Information
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NPI Number | 1770801342
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Entity Type | Organization
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Legal Business Name | KEN NELSON BEHAVIOR SERVICES
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 508 E WARRICK ST.
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City | OWENSVILLE
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State | IN
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Zip | 47665
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Country | US
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Telephone | 812-453-5927
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 822
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City | OWENSVILLE
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State | IN
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Zip | 47665-0822
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Country | US
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Telephone | 812-453-5927
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KENDALL R NELSON
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Credential | MA, LMFT, LCSW, BCBA
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Telephone | 812-453-5927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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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 | 35000054A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34003111A
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License Number State | IN
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