Provider Demographics
NPI:1154759223
Name:NELSON, AMBER D (LPCC, LCAC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:D
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPCC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 19TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-8899
Mailing Address - Country:US
Mailing Address - Phone:701-857-4232
Mailing Address - Fax:701-852-1190
Practice Address - Street 1:7151 15TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6613
Practice Address - Country:US
Practice Address - Phone:701-857-4232
Practice Address - Fax:701-852-1190
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1695101YA0400X
ND787-6-1-14A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND75025Medicaid