Nelson, Casey

Nelson, Casey is an individual health care provider with primary practice located at 1515 Magnavox Way , Fort Wayne IN 46804-1533. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Nelson, Casey can be contacted via phone (260) 408-1085.

Contact Information

Primary practice address
1515 Magnavox Way Fort Wayne IN 46804-1533
Phone: (260) 408-1085
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 20041856A Indiana
Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities 103TM1800X 20041856A Indiana

Profile Details

NPI number 1750509667
LBN Legal business name Nelson, Casey
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 23rd, 2007
Last updated Dec 12th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750509667 NPPES
Indiana Other 200501870 MEDICAID WAVIER
Indiana MEDICAID 200500290 MEDICAID WAVIER

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