Provider Demographics
NPI:1043727084
Name:NELSON, BREANA M (LPC)
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 WINDWARD ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2618
Mailing Address - Country:US
Mailing Address - Phone:864-242-2213
Mailing Address - Fax:
Practice Address - Street 1:8587 S MASON MONTGOMERY RD STE 9
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9250
Practice Address - Country:US
Practice Address - Phone:513-549-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0004839Medicaid
OH2910854Medicaid