MEDICARE: DR. AMIRAH R NELSON LPC

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	LPC-7879	ID
2	101YP2500X	Professional Counselor	3028	MS

General Provider Information

NPI Number	:	1952995862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIRAH R NELSON LPC

Provider Business Mailing Address
First Line	:	102 BEAVER RUN CT
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2131
Country	:	US
Telephone Number	:	770-634-6686
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 BEAVER RUN CT
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2131
Country	:	US
Telephone Number	:	770-634-6686
Fax Number	:

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

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	06/03/2026

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