MEDICARE: LAURA 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	101YP2500X	Professional Counselor
2	101YP2500X	Professional Counselor	69128	TX

General Provider Information

NPI Number	:	1275893869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA NELSON

Provider Business Mailing Address
First Line	:	6010 W SPRING CREEK PKWY # 231
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3569
Country	:	US
Telephone Number	:	806-789-4566
Fax Number	:

Provider Business Practice Location Address
First Line	:	6010 W SPRING CREEK PKWY # 231
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3569
Country	:	US
Telephone Number	:	806-789-4566
Fax Number	:

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

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	02/28/2019

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Directions to “ LAURA NELSON ” Practice Location

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