Active NPI
Susan Barbara Nelson, MA, LPCC
- Mental Health Counselor
- Shorewood, MN
National Provider Identifier
1093315657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 881
- Practice address
- 20145 Excelsior Blvd
Shorewood, MN 55331-8730 - Phone
- (612) 554-2555
- NPI assigned
- Oct 31, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 881 | MN | Primary |
Addresses
Primary practice location
20145 Excelsior Blvd
Shorewood, MN 55331-8730
Mailing address
20145 Excelsior Blvd
Shorewood, MN 55331-8730
Phone (612) 554-2555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 881 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604102400000",
"number": "1093315657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20145 EXCELSIOR BLVD",
"city": "SHOREWOOD",
"state": "MN",
"postal_code": "553318730",
"telephone_number": "612-554-2555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20145 EXCELSIOR BLVD",
"city": "SHOREWOOD",
"state": "MN",
"postal_code": "553318730",
"telephone_number": "612-554-2555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "SUSAN",
"middle_name": "BARBARA",
"credential": "MA, LPCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-31",
"last_updated": "2020-10-31",
"certification_date": "2020-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shorewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.