Healthcare Provider Details

I. General information

NPI: 1992698294
Provider Name (Legal Business Name): EMILY NELMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10840 GILMORE WAY
GRASS VALLEY CA
95945-5409
US

IV. Provider business mailing address

14030 MYSTIC MINE RD
NEVADA CITY CA
95959-9028
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-4483
  • Fax:
Mailing address:
  • Phone: 818-731-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250090870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: