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NPI Code Detail

MEDICARE: MARY NELSON

MEDICARE: MARY 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
1101YM0800XMental Health CounselorLA

General Provider Information

NPI Number : 1891227476
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY NELSON
Provider Business Mailing Address
First Line : 1986 HENDERSON LOOP
Second Line :
City : SONDHEIMER
State : LA
Zip : 71276-4847
Country : US
Telephone Number : 318-341-4740
Fax Number :
Provider Business Practice Location Address
First Line : 1986 HENDERSON LOOP
Second Line :
City : SONDHEIMER
State : LA
Zip : 71276-4847
Country : US
Telephone Number : 318-341-4740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2017
Last Update Date : 04/01/2017

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Directions to “ MARY NELSON ” Practice Location

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