Provider Demographics
NPI:1124764956
Name:STEPHANIE NELSON PLLC
Entity type:Organization
Organization Name:STEPHANIE NELSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-410-1860
Mailing Address - Street 1:2765 WYLIE DR TRLR 75
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-3057
Mailing Address - Country:US
Mailing Address - Phone:406-410-1860
Mailing Address - Fax:
Practice Address - Street 1:2765 WYLIE DR TRLR 80
Practice Address - Street 2:
Practice Address - City:EAST HELENA
Practice Address - State:MT
Practice Address - Zip Code:59635-3057
Practice Address - Country:US
Practice Address - Phone:406-410-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHANIE NELSON PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT708942Medicaid