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NPI Code Detail

MEDICARE: SANDRA CHELIST SANDY CHELIST

MEDICARE: SANDRA CHELIST SANDY CHELIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist648CO

General Provider Information

NPI Number : 1134299654
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA CHELIST SANDY CHELIST
Provider Business Mailing Address
First Line : PO BOX 2004
Second Line :
City : EVERGREEN
State : CO
Zip : 80437-2004
Country : US
Telephone Number : 303-670-1339
Fax Number :
Provider Business Practice Location Address
First Line : 3081 BERGEN PEAK DR
Second Line : SUITE 205
City : EVERGREEN
State : CO
Zip : 80439-2200
Country : US
Telephone Number : 303-670-1339
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 07/08/2007

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Directions to “ SANDRA CHELIST SANDY CHELIST” Practice Location

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