Provider Demographics
NPI:1184193740
Name:NIELSEN, JUSTIN LEE (MA, LPC, ACT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:LEE
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MA, LPC, ACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6329
Mailing Address - Country:US
Mailing Address - Phone:605-336-2556
Mailing Address - Fax:605-339-3345
Practice Address - Street 1:310 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6329
Practice Address - Country:US
Practice Address - Phone:605-336-2556
Practice Address - Fax:605-339-3345
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SDLPC20290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)