Provider Demographics
NPI:1164927281
Name:NELSON, ROBYN LEA (MS, EDS)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:LEA
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4072 CAERLEON CIR
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7651
Mailing Address - Country:US
Mailing Address - Phone:479-903-1988
Mailing Address - Fax:479-319-6570
Practice Address - Street 1:1003 SE 14TH ST STE 4
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6897
Practice Address - Country:US
Practice Address - Phone:479-903-1988
Practice Address - Fax:479-319-6570
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1605065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional