Doctor Name: | STACIE LYNNE NELSON |
NPI Number: | 1104169754 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, LAMFT |
License Number: | 2696 |
Business Practice Address: | 265 River St N Delano, MN - 553288266 |
Business Phone Number: | 6125841153 |
Business Fax Number: | |
Mailing Address: | Po Box 752, DELANO |
State: | MN |
Postal Code: | 553280752 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/02/2013 |
NPI Last Update Date: | 04/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2696 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |