Provider Demographics
NPI:1396929881
Name:NELSON, WILLIAM PHILIP (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PHILIP
Last Name:NELSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8592
Mailing Address - Country:US
Mailing Address - Phone:317-782-6505
Mailing Address - Fax:317-782-6929
Practice Address - Street 1:650 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8592
Practice Address - Country:US
Practice Address - Phone:317-782-6505
Practice Address - Fax:317-782-6929
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001207A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health