Healthcare Provider Details

I. General information

NPI: 1376056424
Provider Name (Legal Business Name): CHELSEA DEINES LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 N MAIN ST
LINDSBORG KS
67456-2011
US

IV. Provider business mailing address

340 N MAIN ST
LINDSBORG KS
67456-2011
US

V. Phone/Fax

Practice location:
  • Phone: 417-321-4851
  • Fax:
Mailing address:
  • Phone: 417-321-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2012017071
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5174
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020004196
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: