Individual
JOHN MICHAEL NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
9250 COLUMBIA AVE STE 2E, MUNSTER, IN 46321-3530
(219) 595-0043
(219) 237-2894
Mailing address
9250 COLUMBIA AVE STE 2E, MUNSTER, IN 46321-3530
(219) 595-0043
(219) 237-2894
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39000848A
IN
1041C0700X
Clinical Social Worker
Primary
34000789A
IN
1041C0700X
Clinical Social Worker
39000848A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90000854
BCBSIL
IL
Enumeration date
09/21/2005
Last updated
02/03/2022
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