Provider Demographics
NPI:1871246637
Name:NELMS, CHELSEA BLAIR
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:BLAIR
Last Name:NELMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 N VALDOSTA RD APT 109
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1032
Mailing Address - Country:US
Mailing Address - Phone:317-438-2777
Mailing Address - Fax:
Practice Address - Street 1:3790 OLD US HIGHWAY 41 N STE A
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6865
Practice Address - Country:US
Practice Address - Phone:229-262-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist