Provider Demographics
NPI:1184289449
Name:NELSON, KIRSTEN M (LMHC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 THEODORA ST
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6396
Mailing Address - Country:US
Mailing Address - Phone:575-224-1077
Mailing Address - Fax:
Practice Address - Street 1:945 SALAZAR RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-8231
Practice Address - Country:US
Practice Address - Phone:575-758-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0202171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health