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NPI Code Detail

MEDICARE: CHELSEA TEASDALE LPC

MEDICARE: CHELSEA TEASDALE LPC
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
1101YM0800XMental Health Counselor003958CT

General Provider Information

NPI Number : 1568818896
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHELSEA TEASDALE LPC
Provider Business Mailing Address
First Line : 1007 N MAIN ST
Second Line :
City : DAYVILLE
State : CT
Zip : 06241-2170
Country : US
Telephone Number : 860-774-2020
Fax Number : 860-774-0826
Provider Business Practice Location Address
First Line : 140 N FRONTAGE RD
Second Line :
City : MANSFIELD CENTER
State : CT
Zip : 06250-1648
Country : US
Telephone Number : 864-456-2261
Fax Number : 860-450-1357
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2016
Last Update Date : 05/22/2023

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Directions to “ CHELSEA TEASDALE LPC” Practice Location

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