Provider Demographics
NPI:1366514572
Name:NELSON, PHYLLIS B (LCSW)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:B
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:A200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8673
Mailing Address - Country:US
Mailing Address - Phone:512-342-2777
Mailing Address - Fax:512-241-2833
Practice Address - Street 1:4005 SPICEWOOD SPRINGS RD
Practice Address - Street 2:A200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8673
Practice Address - Country:US
Practice Address - Phone:512-342-2777
Practice Address - Fax:512-241-2833
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00S23PMedicare ID - Type Unspecified