Healthcare Provider Details

I. General information

NPI: 1710398920
Provider Name (Legal Business Name): CHELSEY RICHARD LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WESTRAC DR S
FARGO ND
58103-2338
US

IV. Provider business mailing address

1202 WESTRAC DR S
FARGO ND
58103-2338
US

V. Phone/Fax

Practice location:
  • Phone: 701-412-6723
  • Fax:
Mailing address:
  • Phone: 701-412-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number4966
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4966
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4966
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: