Provider Demographics
NPI:1003034240
Name:NIELSEN, DOUG E (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DOUG
Middle Name:E
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84310-1219
Mailing Address - Country:US
Mailing Address - Phone:801-745-3233
Mailing Address - Fax:
Practice Address - Street 1:1466 N HIGHWAY 89 STE 220
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2738
Practice Address - Country:US
Practice Address - Phone:801-451-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT266439-35011041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered251S00000XAgenciesCommunity/Behavioral Health