MEDICARE: MARIAH NELSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-72029
2	106E00000X	Assistant Behavior Analyst	0188950	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003270281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH NELSON

Provider Business Mailing Address
First Line	:	311 COOL EMBERS LN
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-9616
Country	:	US
Telephone Number	:	941-536-5715
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 SOUTH MAIN ST
Second Line	:	1ST FLOOR
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2923
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	01/14/2026

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Directions to “ MARIAH NELSON ” Practice Location

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