Healthcare Provider Details

I. General information

NPI: 1285221341
Provider Name (Legal Business Name): CHELSEY WOODS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E 1ST ST
DAYTON OH
45402-1303
US

IV. Provider business mailing address

226 N BROMFIELD RD
DAYTON OH
45429-2746
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3211
  • Fax:
Mailing address:
  • Phone: 937-418-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2002945
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: