Provider Demographics
NPI:1861727869
Name:NELSON, MARI CHRISTINA (LCPC, ICADC, DBTC)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:CHRISTINA
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCPC, ICADC, DBTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 BLUE LAKES BLVD N
Mailing Address - Street 2:SUITE #108
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4800
Mailing Address - Country:US
Mailing Address - Phone:208-421-4293
Mailing Address - Fax:
Practice Address - Street 1:488 BLUE LAKES BLVD. NORTH
Practice Address - Street 2:SUITE #108
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-421-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6017101YM0800X
ID1133008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)