Provider Demographics
NPI:1093825366
Name:NAGLE, NELSON LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:LEE
Last Name:NAGLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN AVE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5808
Mailing Address - Country:US
Mailing Address - Phone:512-218-8538
Mailing Address - Fax:512-218-1821
Practice Address - Street 1:400 W MAIN AVE
Practice Address - Street 2:SUITE #106
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-5808
Practice Address - Country:US
Practice Address - Phone:512-218-8538
Practice Address - Fax:512-218-1821
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3067LCOtherBLUE CROSS BLUE SHIELD
TX10011768OtherAMERIGROUP
TX160750OtherVALUE OPTIONS
TX5405068OtherAETNA