Provider Demographics
NPI:1386988640
Name:NELSON, LAURA A (LSCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5843 W SWIFT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-0465
Mailing Address - Country:US
Mailing Address - Phone:904-483-0375
Mailing Address - Fax:
Practice Address - Street 1:5843 W SWIFT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-0465
Practice Address - Country:US
Practice Address - Phone:904-483-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS37311041C0700X
CALCSW617741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3731OtherBEHAVIORAL SCIENCES REGULATORY BOARD