Provider Demographics
NPI:1548231970
Name:NIELSEN, DANE (LPC)
Entity Type:Individual
Prefix:MR
First Name:DANE
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DONS WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-620-5130
Mailing Address - Fax:501-620-5231
Practice Address - Street 1:505 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-3931
Practice Address - Country:US
Practice Address - Phone:501-624-7111
Practice Address - Fax:501-620-5231
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0408035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114108OtherMHN NETWORK
256015OtherCOMPSYCH
AR507000025600OtherQUAL-CHOICE
AR71-0401764OtherCORPHEALTH
AR2245132OtherCIGNA BEHAVIORAL HEALTH
AR811960000OtherMAGELLAN
AR977750OtherUSA MANAGED CARE
AR7963851OtherAETNA
11626153OtherCAQH
AR116399726Medicaid
AR5Y486OtherBLUE CROSS & BLUE SHIELD
AR977750OtherUSA MANAGED CARE
$$$$$$$$$OtherUNITY MANAGED MENTAL HLTH
AR114108OtherMHN NETWORK