Individual
MRS. TAY ANGELL NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
559 CLUBHOUSE DR, PEARL, MS 39208-9506
(601) 932-0958
Mailing address
559 CLUBHOUSE DR, PEARL, MS 39208-9506
(601) 932-0958
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C5559
MS
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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