Provider Demographics
NPI:1659389914
Name:NELSON, LAURENCE CLYDE (D MIN)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:CLYDE
Last Name:NELSON
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S BROADWAY
Mailing Address - Street 2:SUITE #300
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4038
Mailing Address - Country:US
Mailing Address - Phone:405-341-8671
Mailing Address - Fax:405-341-8671
Practice Address - Street 1:2500 S BROADWAY
Practice Address - Street 2:SUITE #300
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4038
Practice Address - Country:US
Practice Address - Phone:405-341-8671
Practice Address - Fax:405-341-8671
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK461101YP2500X
OK061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist