Individual
MRS. SHELLY R NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CSW, CSAC
Contact information
Practice address
2825 N MAYFAIR RD, SUITE 209, WAUWATOSA, WI 53222-4406
(414) 630-1028
(414) 256-0070
Mailing address
2825 N MAYFAIR RD STE 209, SUITE 209, WAUWATOSA, WI 53222-4406
(414) 630-1028
(414) 256-0070
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16032-132
WI
101YP2500X
Professional Counselor
Primary
3990-125
WI
104100000X
Social Worker
2620-120
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43731400
—
WI
Enumeration date
02/21/2008
Last updated
01/20/2017
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