Provider Demographics
NPI:1053732891
Name:NELSON, DENA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DENA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88211-0689
Mailing Address - Country:US
Mailing Address - Phone:575-746-3812
Mailing Address - Fax:575-746-8978
Practice Address - Street 1:1106 W QUAY AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1826
Practice Address - Country:US
Practice Address - Phone:575-746-3812
Practice Address - Fax:575-746-8978
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-078221041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool