Healthcare Provider Details

I. General information

NPI: 1376911347
Provider Name (Legal Business Name): CHELSEA ELIZABETH DEAN BUTAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHELSEA ELIZABETH DEAN

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 FREMONT AVE N
MINNEAPOLIS MN
55412
US

IV. Provider business mailing address

3300 FREMONT AVE N
MINNEAPOLIS MN
55412-2405
US

V. Phone/Fax

Practice location:
  • Phone: 612-588-9411
  • Fax: 612-522-6627
Mailing address:
  • Phone: 612-588-9411
  • Fax: 612-522-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6357
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: