Provider Demographics
NPI:1497982151
Name:NELSON, JONATHAN SCOTT (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:NELSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 CROSS PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5302
Mailing Address - Country:US
Mailing Address - Phone:815-222-3958
Mailing Address - Fax:815-394-3990
Practice Address - Street 1:129 PHELPS AVE STE 204
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2447
Practice Address - Country:US
Practice Address - Phone:815-222-3958
Practice Address - Fax:815-394-3990
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25596101YA0400X
101YM0800X
IL180-007240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health