Provider Demographics
NPI:1821535162
Name:NELSON, STACY LYNN
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N. GREEN VALLEY PARKWAY
Mailing Address - Street 2:BLDG D SUITE 116-118
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:702-605-2766
Mailing Address - Fax:702-938-9056
Practice Address - Street 1:2501 N GREEN VALLEY PKWY STE 116
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2158
Practice Address - Country:US
Practice Address - Phone:702-938-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI620101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor