Provider Demographics
NPI:1497811913
Name:NELSON, W. MICHAEL III (PHD)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:MICHAEL
Last Name:NELSON
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHOLOGY, XAVIER UNIVERSTIY
Mailing Address - Street 2:3800 VICTORY PARKWAY
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-6411
Mailing Address - Country:US
Mailing Address - Phone:513-745-3298
Mailing Address - Fax:513-745-4380
Practice Address - Street 1:DEPARTMENT OF PSYCHLOGY, XAVIER UNIVERSITY
Practice Address - Street 2:3800 VICTORY PARKWAY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-6411
Practice Address - Country:US
Practice Address - Phone:513-745-3298
Practice Address - Fax:513-745-4380
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical