Provider Demographics
NPI:1538496310
Name:NELSON, ELRICK (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ELRICK
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 GREEN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3034
Mailing Address - Country:US
Mailing Address - Phone:985-447-8788
Mailing Address - Fax:985-447-8788
Practice Address - Street 1:206 GREEN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3034
Practice Address - Country:US
Practice Address - Phone:985-447-8788
Practice Address - Fax:985-447-8788
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3821103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling