Provider Demographics
NPI:1861509952
Name:NELSEN, SUSAN DIANE (MS, LMHP, CPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:NELSEN
Suffix:
Gender:F
Credentials:MS, LMHP, CPC, NCC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11920 BURT STREET
Mailing Address - Street 2:#190
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154
Mailing Address - Country:US
Mailing Address - Phone:402-965-4004
Mailing Address - Fax:402-965-4232
Practice Address - Street 1:11920 BURT STREET
Practice Address - Street 2:#190
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:402-965-4004
Practice Address - Fax:402-965-4232
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1546101YM0800X
NE957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84677OtherBLUECROSS BLUESHIELD
NE100253006-00Medicaid