Provider Demographics
NPI:1720648017
Name:NELSON, ELAINE ALTHEA (LMHC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:ALTHEA
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:ALTHEA
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1041 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MANGONIA PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2402
Mailing Address - Country:US
Mailing Address - Phone:561-383-8000
Mailing Address - Fax:
Practice Address - Street 1:1041 45TH ST
Practice Address - Street 2:
Practice Address - City:MANGONIA PARK
Practice Address - State:FL
Practice Address - Zip Code:33407-2402
Practice Address - Country:US
Practice Address - Phone:561-383-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH14958OtherPROFESSIONAL LICENSE