Provider Demographics
NPI:1689124216
Name:NELSON, DOUGLAS ALAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:NELSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5808 BALCONES DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4255
Mailing Address - Country:US
Mailing Address - Phone:512-994-0120
Mailing Address - Fax:888-463-2310
Practice Address - Street 1:5808 BALCONES DR
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4255
Practice Address - Country:US
Practice Address - Phone:512-994-0120
Practice Address - Fax:888-463-2310
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69424101YP2500X
TX201800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist