Basic Information
| Provider Information | |||||||||
| NPI: | 1215404397 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSEN | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4219 SW JUNEAU ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981361621 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4219 SW JUNEAU ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981361621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062075395 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2018 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | LF61186433 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.