Healthcare Provider Details

I. General information

NPI: 1477024719
Provider Name (Legal Business Name): CHELSEA CHOAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W SPRUCE ST STE J
MISSOULA MT
59802-4047
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3350
  • Fax: 406-327-3355
Mailing address:
  • Phone: 406-327-3350
  • Fax: 406-327-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-34560
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: