Individual
JERRY NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2650 W BROADWAY, LOUISVILLE, KY 40211-1333
(502) 589-1100
(502) 589-8771
Mailing address
101 W MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1423
(502) 589-8600
(502) 589-8771
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
166933
KY
Other
Enumeration date
03/14/2007
Last updated
06/24/2016
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