Provider Demographics
NPI:1043767189
Name:NELSON, TAKEISHA
Entity Type:Individual
Prefix:
First Name:TAKEISHA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 GENERAL DEGAULLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6757
Mailing Address - Country:US
Mailing Address - Phone:504-363-7449
Mailing Address - Fax:504-363-7077
Practice Address - Street 1:3520 GENERAL DEGAULLE DR
Practice Address - Street 2:SUITE # 4070
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114
Practice Address - Country:US
Practice Address - Phone:504-363-7449
Practice Address - Fax:504-363-7077
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health