Provider Demographics
NPI:1669083085
Name:NELSEN, KATHERINE (MA, LPC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:NELSEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 TULIP LOTUS CV
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2231
Mailing Address - Country:US
Mailing Address - Phone:651-747-6759
Mailing Address - Fax:
Practice Address - Street 1:1004 TULIP LOTUS CV
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-2231
Practice Address - Country:US
Practice Address - Phone:651-747-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health