MEDICARE: DR. JULIE B. NELSON PH.D

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	103TC0700X	Clinical Psychologist	448	LA

General Provider Information

NPI Number	:	1619027976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE B. NELSON PH.D

Provider Business Mailing Address
First Line	:	11914 JUSTICE AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2372
Country	:	US
Telephone Number	:	225-293-1387
Fax Number	:	225-291-7133

Provider Business Practice Location Address
First Line	:	11914 JUSTICE AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2372
Country	:	US
Telephone Number	:	225-293-1387
Fax Number	:	225-291-7133

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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