Provider Demographics
NPI:1134655913
Name:NELSON, ELIZABETH (MS, LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, LADC, LPCC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HALVORSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-1934
Mailing Address - Country:US
Mailing Address - Phone:218-346-6100
Mailing Address - Fax:218-249-1507
Practice Address - Street 1:1401 8TH ST S STE 3
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3606
Practice Address - Country:US
Practice Address - Phone:218-284-1800
Practice Address - Fax:218-600-5484
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304404101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10348381CDTMedicare UPIN