Provider Demographics
NPI:1174944219
Name:NELSON, MARGENE MONTGOMERY (LPC)
Entity type:Individual
Prefix:MS
First Name:MARGENE
Middle Name:MONTGOMERY
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4611
Mailing Address - Country:US
Mailing Address - Phone:405-820-5698
Mailing Address - Fax:405-359-0555
Practice Address - Street 1:16301 SONOMA PARK DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2091
Practice Address - Country:US
Practice Address - Phone:405-246-5433
Practice Address - Fax:405-562-1451
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health