Provider Demographics
NPI:1801360730
Name:NELSON, LAURIE LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:LYNN
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 1:8801 W OKLAHOMA AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4571
Mailing Address - Country:US
Mailing Address - Phone:414-469-4951
Mailing Address - Fax:
Practice Address - Street 1:1730 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1701
Practice Address - Country:US
Practice Address - Phone:414-265-6360
Practice Address - Fax:414-265-8151
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5919-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional