Provider Demographics
NPI:1083196950
Name:NELSON, DEREK (MS)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W SILVER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-1659
Mailing Address - Country:US
Mailing Address - Phone:405-201-3598
Mailing Address - Fax:
Practice Address - Street 1:9700 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6917
Practice Address - Country:US
Practice Address - Phone:405-735-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health