Provider Demographics
NPI:1316111735
Name:NELSON, RYAN P (LLMSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:NELSON
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14930 LAPLAISANCE RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3880
Mailing Address - Country:US
Mailing Address - Phone:734-240-3850
Mailing Address - Fax:734-240-3863
Practice Address - Street 1:14930 LAPLAISANCE RD
Practice Address - Street 2:SUITE 123
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3880
Practice Address - Country:US
Practice Address - Phone:734-240-3850
Practice Address - Fax:734-240-3863
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010880061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical