Healthcare Provider Details

I. General information

NPI: 1851063622
Provider Name (Legal Business Name): MARTIN LEE NELMS CRM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1966 GARDEN AVE
EUGENE OR
97403-1933
US

IV. Provider business mailing address

1966 GARDEN AVE
EUGENE OR
97403-1933
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-9190
  • Fax:
Mailing address:
  • Phone: 541-505-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHA-R-8047
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number105649
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-6137
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: