Provider Demographics
NPI:1720002157
Name:NELSEN, STACY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:NELSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S. AUSTIN AVE #110-295
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626
Mailing Address - Country:US
Mailing Address - Phone:512-818-6747
Mailing Address - Fax:512-986-7161
Practice Address - Street 1:1101 ARROW POINT DR
Practice Address - Street 2:STE 207
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7737
Practice Address - Country:US
Practice Address - Phone:512-818-6747
Practice Address - Fax:512-986-7161
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical