Provider Demographics
NPI:1073236634
Name:NELSON, COLLIS CODY (MSSW, LMSW, SWC)
Entity Type:Individual
Prefix:MR
First Name:COLLIS
Middle Name:CODY
Last Name:NELSON
Suffix:
Gender:M
Credentials:MSSW, LMSW, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2878 SPRINGVALE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-3241
Mailing Address - Country:US
Mailing Address - Phone:423-736-3323
Mailing Address - Fax:
Practice Address - Street 1:2878 SPRINGVALE RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3241
Practice Address - Country:US
Practice Address - Phone:423-736-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.0000000991104100000X
TN0000013017104100000X
TNLSW0000013017104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker