Provider Demographics
NPI:1346690054
Name:NIELSEN THERAPY SERVICES
Entity Type:Organization
Organization Name:NIELSEN THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, LADC
Authorized Official - Phone:320-630-5026
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:ASKOV
Mailing Address - State:MN
Mailing Address - Zip Code:55704-0066
Mailing Address - Country:US
Mailing Address - Phone:320-630-5026
Mailing Address - Fax:
Practice Address - Street 1:6333 H.C. ANDERSON ALLE
Practice Address - Street 2:
Practice Address - City:ASKOV
Practice Address - State:MN
Practice Address - Zip Code:55704
Practice Address - Country:US
Practice Address - Phone:320-296-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01138251S00000X
MN303610251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========Medicaid