Provider Demographics
NPI:1841426814
Name:NILSEN, KEITH (MS, LPC, MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:NILSEN
Suffix:
Gender:M
Credentials:MS, LPC, MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CUMBERLAND BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1805
Mailing Address - Country:US
Mailing Address - Phone:931-349-4533
Mailing Address - Fax:423-728-6449
Practice Address - Street 1:801 N HOLTZCLAW AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1236
Practice Address - Country:US
Practice Address - Phone:423-697-5985
Practice Address - Fax:423-697-5999
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3840101Y00000X
TN3734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor