Basic Information
| Provider Information | |||||||||
| NPI: | 1548231970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIELSEN | ||||||||
| FirstName: | DANE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 DONS WAY | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016205130 | ||||||||
| FaxNumber: | 5016205231 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 W GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719013931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016247111 | ||||||||
| FaxNumber: | 5016205231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 12/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P0408035 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 114108 | 01 | AR | MHN NETWORK | OTHER | 256015 | 01 | COMPSYCH | OTHER | 507000025600 | 01 | AR | QUAL-CHOICE | OTHER | 71-0401764 | 01 | AR | CORPHEALTH | OTHER | 2245132 | 01 | AR | CIGNA BEHAVIORAL HEALTH | OTHER | 811960000 | 01 | AR | MAGELLAN | OTHER | 977750 | 01 | AR | USA MANAGED CARE | OTHER | 7963851 | 01 | AR | AETNA | OTHER | 11626153 | 01 | CAQH | OTHER | 116399726 | 05 | AR | MEDICAID | 5Y486 | 01 | AR | BLUE CROSS & BLUE SHIELD | OTHER |