Provider Demographics
NPI:1467091199
Name:NELSON, LACONIA RAYELLE (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:LACONIA
Middle Name:RAYELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
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 91419
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77291-1419
Mailing Address - Country:US
Mailing Address - Phone:713-585-1153
Mailing Address - Fax:
Practice Address - Street 1:13223 MERSMANN CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1470
Practice Address - Country:US
Practice Address - Phone:713-376-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional