Provider Demographics
NPI:1942503008
Name:NELSON, ELIZABETH R (BS, MS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E WILSON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-4165
Mailing Address - Country:US
Mailing Address - Phone:405-878-7400
Mailing Address - Fax:405-878-5558
Practice Address - Street 1:905 E. WILSON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3263
Practice Address - Country:US
Practice Address - Phone:405-878-7400
Practice Address - Fax:405-878-5558
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional