Provider Demographics
NPI:1881823433
Name:NELSON, EDWARD MAX (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MAX
Last Name:NELSON
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 COMMUNICATIONS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8914
Mailing Address - Country:US
Mailing Address - Phone:214-577-0801
Mailing Address - Fax:
Practice Address - Street 1:3028 COMMUNICATIONS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8914
Practice Address - Country:US
Practice Address - Phone:214-577-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-03
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health