Provider Demographics
NPI:1366130908
Name:NELSON, NICOLE LEE (LCPC, MS)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2760
Mailing Address - Country:US
Mailing Address - Phone:406-263-2832
Mailing Address - Fax:
Practice Address - Street 1:311 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2760
Practice Address - Country:US
Practice Address - Phone:406-263-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-64823101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional