1023198702 NPI number — MR. STEVEN PAUL NELSON MSW, LCSW

Table of content: MR. STEVEN PAUL NELSON MSW, LCSW (NPI 1023198702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023198702 NPI number — MR. STEVEN PAUL NELSON MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
STEVEN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023198702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11818
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72917-1818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-452-6650
Provider Business Mailing Address Fax Number:
479-452-5847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 23 N & 980 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZARK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-785-9450
Provider Business Practice Location Address Fax Number:
479-452-5847
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  852-C , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100724860A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148416019 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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