Provider Demographics
NPI:1720131303
Name:NELSON, DAYNA MARIE (PSYD)
Entity type:Individual
Prefix:MRS
First Name:DAYNA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8873 QUIMPER PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5620
Mailing Address - Country:US
Mailing Address - Phone:318-686-0012
Mailing Address - Fax:318-686-0012
Practice Address - Street 1:8873 QUIMPER PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5620
Practice Address - Country:US
Practice Address - Phone:318-686-0012
Practice Address - Fax:318-686-0012
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical