Provider Demographics
NPI:1740996693
Name:NELSON, MELANIE C (LCSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:C
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 STOUT ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3113
Mailing Address - Country:US
Mailing Address - Phone:720-204-5760
Mailing Address - Fax:
Practice Address - Street 1:12966 EUCLID ST STE 110
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-9203
Practice Address - Country:US
Practice Address - Phone:720-204-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1100291041C0700X
CALCSW1073201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical