Provider Demographics
NPI:1831337161
Name:NELSON, MARY BETH (LPC, MHSP, MA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC, MHSP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90029
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-0029
Mailing Address - Country:US
Mailing Address - Phone:615-545-9423
Mailing Address - Fax:
Practice Address - Street 1:2200 21ST AVE S STE 209
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4929
Practice Address - Country:US
Practice Address - Phone:615-545-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional