Provider Demographics
NPI:1083045348
Name:MICHELE V. NELSON L.C.S.W. LLC
Entity Type:Organization
Organization Name:MICHELE V. NELSON L.C.S.W. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:VIDRINE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-832-4940
Mailing Address - Street 1:32 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8608
Mailing Address - Country:US
Mailing Address - Phone:504-832-4940
Mailing Address - Fax:504-841-2232
Practice Address - Street 1:3436 MAGAZINE ST # 7164
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2413
Practice Address - Country:US
Practice Address - Phone:504-832-4940
Practice Address - Fax:504-841-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3A011OtherMEDICARE PTAN