Provider Demographics
NPI:1952995862
Name:NELSON, AMIRAH R (LPC)
Entity Type:Individual
Prefix:DR
First Name:AMIRAH
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 WILLIAM BLVD APT 11A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1559
Mailing Address - Country:US
Mailing Address - Phone:770-634-6686
Mailing Address - Fax:
Practice Address - Street 1:879 WILLIAM BLVD APT 11A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1559
Practice Address - Country:US
Practice Address - Phone:770-634-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7879101YM0800X
MS3028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health