| Doctor Name: | MARLA NELSON |
| NPI Number: | 1437552130 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 180.009435 |
| Business Practice Address: | 4806 Dadrian Dr Godfrey, IL - 620351603 |
| Business Phone Number: | 6183740009 |
| Business Fax Number: | |
| Mailing Address: | 307 Henry St, Suite 308 ALTON |
| State: | IL |
| Postal Code: | 620026326 |
| Phone Number: | 6183740009 |
| Fax Number: | 8889741491 |
| NPI Enumeration Date: | 10/08/2014 |
| NPI Last Update Date: | 04/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180.009435 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |