Provider Demographics
NPI:1346331345
Name:NELSON, GREGORY W (MS, LP)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:W
Last Name:NELSON
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Gender:M
Credentials:MS, LP
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Mailing Address - Street 1:PO BOX 8674 1230 E. MAIN STREET
Mailing Address - Street 2:MANKATO CLINIC, LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:507-625-8998
Practice Address - Street 1:1400 MADISON AVENUE SUITE 352
Practice Address - Street 2:MANKATO CLINIC DEPARTMENT OF PSYCHIATRY AND PSYCHOLOGY
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-387-3195
Practice Address - Fax:507-625-8998
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-07-28
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Provider Licenses
StateLicense IDTaxonomies
MNLP2143103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1346331345Medicaid