MEDICARE: MS. CONNIE LEE NELSON MA QMHP LPCMH CCDC

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	101YM0800X	Mental Health Counselor	LPCMH2116	SD
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	ICADC2245
3	101Y00000X	Counselor	45265
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	9605696	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629061221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONNIE LEE NELSON MA QMHP LPCMH CCDC

Provider Business Mailing Address
First Line	:	3803 W TECHNOLOGY CIR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4233
Country	:	US
Telephone Number	:	605-702-4409
Fax Number	:	605-309-7914

Provider Business Practice Location Address
First Line	:	3803 W TECHNOLOGY CIR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4233
Country	:	US
Telephone Number	:	605-702-4409
Fax Number	:	605-309-7914

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	04/09/2026

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