Provider Demographics
NPI:1144410549
Name:NILSSON COUNSELING, LLC
Entity Type:Organization
Organization Name:NILSSON COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NILSSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-905-5230
Mailing Address - Street 1:29895 GREENFIELD RD
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5867
Mailing Address - Country:US
Mailing Address - Phone:248-905-5230
Mailing Address - Fax:248-905-5233
Practice Address - Street 1:29895 GREENFIELD RD
Practice Address - Street 2:SUITE 104B
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5867
Practice Address - Country:US
Practice Address - Phone:248-905-5230
Practice Address - Fax:248-905-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801035749251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health