Provider Demographics
NPI:1952037301
Name:NELSON-BELL, LARONES V
Entity Type:Individual
Prefix:
First Name:LARONES
Middle Name:V
Last Name:NELSON-BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LARONES
Other - Middle Name:VIRTERRIA
Other - Last Name:NELSON-BELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, NCC, PLPC
Mailing Address - Street 1:500 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:MINER
Mailing Address - State:MO
Mailing Address - Zip Code:63801-3858
Mailing Address - Country:US
Mailing Address - Phone:573-931-1809
Mailing Address - Fax:
Practice Address - Street 1:760 PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5736
Practice Address - Country:US
Practice Address - Phone:573-471-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021018618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO19284Medicaid