Individual
KIM ALEXANDER NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S, LPC
Contact information
Practice address
22480 DUFF LN, MIDDLETON, ID 83644-6041
(208) 800-2758
Mailing address
22480 DUFF LN, MIDDLETON, ID 83644-6041
(208) 800-2758
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-6361
ID
101YP2500X
Professional Counselor
LPC-6027
ID
Other
Enumeration date
11/03/2016
Last updated
05/10/2021
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