MEDICARE: HEATHER KAYE NELSON LPCC

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	261916	KY

General Provider Information

NPI Number	:	1437658887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER KAYE NELSON LPCC

Provider Business Mailing Address
First Line	:	1215 SOUTHTOWN BLVD STE 403
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-7407
Country	:	US
Telephone Number	:	270-903-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 SOUTHTOWN BLVD STE 403
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-7407
Country	:	US
Telephone Number	:	270-903-5151
Fax Number	:

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

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	03/22/2024

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