Provider Demographics
NPI:1588927966
Name:NELSON, NEWEL IVAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:NEWEL
Middle Name:IVAN
Last Name:NELSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5803
Mailing Address - Country:US
Mailing Address - Phone:801-580-5823
Mailing Address - Fax:
Practice Address - Street 1:3565 LEXINGTON DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5803
Practice Address - Country:US
Practice Address - Phone:801-580-5823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4918394-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical