Provider Demographics
NPI:1609054832
Name:NELSON, EDNA M (MS, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 NW 92ND ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8424
Mailing Address - Country:US
Mailing Address - Phone:405-496-1767
Mailing Address - Fax:405-609-1659
Practice Address - Street 1:9001 NW 92ND ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8424
Practice Address - Country:US
Practice Address - Phone:405-496-1767
Practice Address - Fax:405-609-1659
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2949, 0879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional