Provider Demographics
NPI:1689756355
Name:NELSON, GEORGIA A (LPC)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27272
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0137
Mailing Address - Country:US
Mailing Address - Phone:402-617-0450
Mailing Address - Fax:480-203-2190
Practice Address - Street 1:36600 N PIMA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:402-617-0450
Practice Address - Fax:480-203-2190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2058101YM0800X
AZ14576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36008OtherMIDLANDS CHOICE
NE47083791626Medicaid
NE84282OtherBLUE CROSS/BLUE SHIELD