Provider Demographics
NPI:1538123245
Name:NELSON, LAWRENCE HAROLD II (MSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:HAROLD
Last Name:NELSON
Suffix:II
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4122
Mailing Address - Country:US
Mailing Address - Phone:303-449-8895
Mailing Address - Fax:303-426-1390
Practice Address - Street 1:2315 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4122
Practice Address - Country:US
Practice Address - Phone:303-449-8895
Practice Address - Fax:303-426-1390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9820201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical