Provider Demographics
NPI:1376217083
Name:NELMS, CASEY AMANDA (MSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:AMANDA
Last Name:NELMS
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 W 3RD ST APT 113
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-7613
Mailing Address - Country:US
Mailing Address - Phone:601-213-7584
Mailing Address - Fax:
Practice Address - Street 1:3685 MOTOR AVE STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5746
Practice Address - Country:US
Practice Address - Phone:601-213-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical