1689756355 NPI number — GEORGIA A NELSON LPC

Table of content: GEORGIA A NELSON LPC (NPI 1689756355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689756355 NPI number — GEORGIA A NELSON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
GEORGIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

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:
1689756355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27272
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85255-0137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-617-0450
Provider Business Mailing Address Fax Number:
480-203-2190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36600 N PIMA RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
CAREFREE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-617-0450
Provider Business Practice Location Address Fax Number:
480-203-2190
Provider Enumeration Date:
10/20/2006

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: 101YM0800X , with the licence number:  2058 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 14576 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36008 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47083791626 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84282 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com