Provider Demographics
NPI:1609518216
Name:NELSON, DEBRA ANN (MA, LAC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5606
Mailing Address - Country:US
Mailing Address - Phone:605-332-3236
Mailing Address - Fax:605-334-5026
Practice Address - Street 1:2519 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5606
Practice Address - Country:US
Practice Address - Phone:605-332-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20091856101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)