Provider Demographics
NPI:1023607561
Name:NELSON, MARCELLA
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 WOODHAVEN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FERN CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4909
Mailing Address - Country:US
Mailing Address - Phone:502-777-9369
Mailing Address - Fax:
Practice Address - Street 1:5115 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2601
Practice Address - Country:US
Practice Address - Phone:502-777-9369
Practice Address - Fax:502-719-8161
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker