Healthcare Provider Details

I. General information

NPI: 1134613219
Provider Name (Legal Business Name): CHELSEA SIMKHADA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA ANDERSON

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date: 07/27/2021
Reactivation Date: 09/30/2021

III. Provider practice location address

890 WASHINGTON AVE STE 150
HOLLAND MI
49423-7702
US

IV. Provider business mailing address

877 S KINGWOOD CT
HOLLAND MI
49424-1723
US

V. Phone/Fax

Practice location:
  • Phone: 616-594-6047
  • Fax:
Mailing address:
  • Phone: 617-653-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801110564
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: