Healthcare Provider Details

I. General information

NPI: 1104570977
Provider Name (Legal Business Name): CHELSEA LANDWEHR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA PORTER

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5095 BEATLINE RD
LONG BEACH MS
39560-3814
US

IV. Provider business mailing address

5095 BEATLINE RD
LONG BEACH MS
39560-3814
US

V. Phone/Fax

Practice location:
  • Phone: 228-223-2205
  • Fax:
Mailing address:
  • Phone: 228-223-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM9866
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC11574
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: