Provider Demographics
NPI:1437360021
Name:NELSON, BEAU AUGUSTUS (DBH, LCSW)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:AUGUSTUS
Last Name:NELSON
Suffix:
Gender:M
Credentials:DBH, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 HILLCREST RD STE D116
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1527
Mailing Address - Country:US
Mailing Address - Phone:972-980-9911
Mailing Address - Fax:972-980-9910
Practice Address - Street 1:1 E BROWARD BLVD STE 700
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1876
Practice Address - Country:US
Practice Address - Phone:954-903-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical