Individual provider Active NPI

Pearl Richard Nelson, PH.D, LPC

  • Professional Counselor
  • Lake Charles, LA
National Provider Identifier
1497063473
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2476 Issued in LA
Practice address
1925 Enterprise Blvd
Lake Charles, LA 70601-6371
Phone
(337) 429-5129
NPI assigned
Sep 23, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 2476 LA Primary

Addresses

Primary practice location

1925 Enterprise Blvd
Lake Charles, LA 70601-6371

Mailing address

1925 Enterprise Blvd
Lake Charles, LA 70601-6371
Phone (337) 429-5129

Other identifiers 1

IdentifierTypeStateIssuer
600705501MedicaidLA

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
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2476LAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Resolutions Counseling Services Professional CurrentSince Sep 23, 2021 Accepting new patients

Locations

1925 Enterprise Blvd
Lake Charles, LA 70601
Phone (337) 429-5129

3501 5th Ave
Ste A
Lake Charles, LA 70607
Phone (337) 310-0153

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1497063473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 ENTERPRISE BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706016371",
            "telephone_number": "337-429-5129",
            "fax_number": "337-214-2077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 ENTERPRISE BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706016371",
            "telephone_number": "337-429-5129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "PEARL",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "PH.D, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-23",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "2476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600705501",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.