Provider Information for 1326039843
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CORY ALAN NELSON LPC QMHP
Sex: Male
NPI: 1326039843
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1326039843 | ||||||||
| Enumeration Date | 2005-11-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1028 WALNUT ST YANKTON, SD 57078-2910 United States Phone: 605-665-4606 | Fax:605-665-4673 | ||||||||
| Primary Practice Address | 1028 WALNUT ST LEWIS & CLARK BHS YANKTON, SD 57078-2910 United States Phone: 605-665-4606 | Fax:605-665-4673 | ||||||||
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