Provider Demographics
NPI:1548578537
Name:NELSON, INGER WARREN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:INGER
Middle Name:WARREN
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O CHRISTIAN LIFE CATHEDRAL
Mailing Address - Street 2:1285 E MILLSAP RD
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-502-2095
Mailing Address - Fax:479-521-8181
Practice Address - Street 1:1285 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5179
Practice Address - Country:US
Practice Address - Phone:479-502-2095
Practice Address - Fax:479-521-8181
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR947-C101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health