Healthcare Provider Details

I. General information

NPI: 1780159418
Provider Name (Legal Business Name): CHELYSE MYERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17011 BEACH BLVD STE 300
HUNTINGTON BEACH CA
92647-5950
US

IV. Provider business mailing address

17011 BEACH BLVD STE 300
HUNTINGTON BEACH CA
92647-5950
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-2620
  • Fax:
Mailing address:
  • Phone: 714-378-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: