Provider Demographics
NPI:1952095606
Name:NELSON, BRENDA LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOUISE
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 1:6655 N CANYON CREST DR UNIT 20201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-3799
Mailing Address - Country:US
Mailing Address - Phone:608-417-9776
Mailing Address - Fax:
Practice Address - Street 1:6655 N CANYON CREST DR UNIT 20201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-3799
Practice Address - Country:US
Practice Address - Phone:608-417-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-206961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical