Provider Demographics
NPI:1376609479
Name:NELSON, WILMA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1021
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-1021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 N 3RD ST
Practice Address - Street 2:SUITE H
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2476
Practice Address - Country:US
Practice Address - Phone:406-363-5781
Practice Address - Fax:406-363-5781
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0250699Medicaid