Provider Demographics
NPI:1770036634
Name:NELSON, KAREN L (LPCC-S, CEAP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPCC-S, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 DAYTON XENIA RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-4305
Mailing Address - Country:US
Mailing Address - Phone:937-903-6606
Mailing Address - Fax:
Practice Address - Street 1:3095 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-4305
Practice Address - Country:US
Practice Address - Phone:937-903-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional