MEDICARE: DR. MARY LEE NELSON PHD.

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	103T00000X	Psychologist	2010009608	MO

General Provider Information

NPI Number	:	1427928050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LEE NELSON PHD.

Provider Business Mailing Address
First Line	:	10311 FOREST BROOK LN APT D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-5844
Country	:	US
Telephone Number	:	775-990-3106
Fax Number	:

Provider Business Practice Location Address
First Line	:	10311 FOREST BROOK LN APT D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-5844
Country	:	US
Telephone Number	:	775-990-3106
Fax Number	:

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

Provider Enumeration Date	:	11/08/2025
Last Update Date	:	12/08/2025

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