| Doctor Name: | MS. LILLIAN ANN NELSON |
| NPI Number: | 1649510595 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 200471350A |
| Business Practice Address: | 311 W Main St Wilburton, OK - 745784047 |
| Business Phone Number: | 9184650909 |
| Business Fax Number: | 9184650404 |
| Mailing Address: | 311 W Main St, WILBURTON |
| State: | OK |
| Postal Code: | 745784047 |
| Phone Number: | 9184650909 |
| Fax Number: | 9184650404 |
| NPI Enumeration Date: | 02/28/2013 |
| NPI Last Update Date: | 02/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TR0400X |
| License Number: | 200471350A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |