Healthcare Provider Details

I. General information

NPI: 1134839657
Provider Name (Legal Business Name): CHELSEA ELLSWORTH LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMERALD ST STE D
KEENE NH
03431-3680
US

IV. Provider business mailing address

31 SOUTH ST
TROY NH
03465-2307
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone: 978-894-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5740
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: