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NPI Code Detail

MEDICARE: MR. JUSTIN LEE NIELSEN MA, LPC, ACT

MEDICARE: MR. JUSTIN LEE NIELSEN MA, LPC, ACT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health CounselorLPC20290SD

General Provider Information

NPI Number : 1184193740
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUSTIN LEE NIELSEN MA, LPC, ACT
Provider Business Mailing Address
First Line : 310 S 1ST AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-6329
Country : US
Telephone Number : 605-336-2556
Fax Number : 605-339-3345
Provider Business Practice Location Address
First Line : 310 S 1ST AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-6329
Country : US
Telephone Number : 605-336-2556
Fax Number : 605-339-3345
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2018
Last Update Date : 11/19/2018

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