Provider Demographics
NPI:1932379674
Name:NELSON, DORIS JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:JEAN
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 1:9017 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1749
Mailing Address - Country:US
Mailing Address - Phone:502-499-9993
Mailing Address - Fax:
Practice Address - Street 1:9017 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1749
Practice Address - Country:US
Practice Address - Phone:502-499-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82004250Medicaid
KY82900036Medicaid
KY1530202Medicare PIN
KY82900036Medicaid