Robert Douglas Nelson, LADC
Individual provider Active NPI Counselor · Tamarack, MN
NPI 1144875600 · NPPES record last updated Aug 1, 2019
Key facts
- NPI
- 1144875600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 302246 (MN)
- Practice address
- 14040 480TH St
Tamarack, MN 55787-4429 - Phone
- (218) 426-4518
- NPI assigned
- Aug 1, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302246 | MN | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 302246 | MN | Yes |
Addresses
Primary practice location
14040 480TH St
Tamarack, MN 55787-4429
Mailing address
14040 480TH St
Tamarack, MN 55787-4429
Phone (218) 426-4518
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.