Provider Demographics
NPI:1831663814
Name:NELSON, KATIE LYNN (MA, LPCC)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:BURGGRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:12580 192ND CT NW STE F
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-5085
Mailing Address - Country:US
Mailing Address - Phone:218-251-1546
Mailing Address - Fax:
Practice Address - Street 1:23 PINE ST N
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1320
Practice Address - Country:US
Practice Address - Phone:320-679-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health