Provider Demographics
NPI:1093730111
Name:NELSON, JULIET (LCP)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 WAKARUSA DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4775
Mailing Address - Country:US
Mailing Address - Phone:785-424-7770
Mailing Address - Fax:785-424-7733
Practice Address - Street 1:1307 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3431
Practice Address - Country:US
Practice Address - Phone:785-424-7770
Practice Address - Fax:785-424-7733
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004324790002Medicaid