Provider Demographics
NPI:1083685168
Name:NELSON, MARGARET ROSE (MS, LPC, LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, LPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 S DUNN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2585
Mailing Address - Country:US
Mailing Address - Phone:660-582-5353
Mailing Address - Fax:
Practice Address - Street 1:2416 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-3624
Practice Address - Country:US
Practice Address - Phone:660-562-2353
Practice Address - Fax:660-562-2933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001435101Y00000X
MO0028331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM490884Medicare ID - Type UnspecifiedPROVIDER NUMBER
MOR30670Medicare UPIN