Provider Demographics
NPI:1598240202
Name:NELSON, EMILY ELLEN (LMHCA, SUDP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELLEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMHCA, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 236TH ST SW APT L108
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-6318
Mailing Address - Country:US
Mailing Address - Phone:425-305-0849
Mailing Address - Fax:
Practice Address - Street 1:4109 236TH ST SW APT L108
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-6318
Practice Address - Country:US
Practice Address - Phone:425-305-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60698144101YA0400X
WACG60899249101YM0800X
WAMC60995796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty