Provider Demographics
NPI:1982780391
Name:NELSON, LORI A (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, LPC
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 1607
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-1607
Mailing Address - Country:US
Mailing Address - Phone:907-260-7888
Mailing Address - Fax:907-260-7875
Practice Address - Street 1:40680 HUCKABAY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-0680
Practice Address - Country:US
Practice Address - Phone:907-260-7888
Practice Address - Fax:907-260-7875
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2973101YA0400X
AK473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional