Provider Demographics
NPI:1568096881
Name:NELSON, BROOKE (LSCSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LSCSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15201 S KAW DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3764
Mailing Address - Country:US
Mailing Address - Phone:913-708-0916
Mailing Address - Fax:
Practice Address - Street 1:10551 BARKLEY ST STE 500
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1892
Practice Address - Country:US
Practice Address - Phone:913-738-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070248921041C0700X
KS42191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical