Healthcare Provider Details

I. General information

NPI: 1235516089
Provider Name (Legal Business Name): CHELSIE CIERRA HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW FRAZER AVE STE 212
PENDLETON OR
97801-2802
US

IV. Provider business mailing address

1288 SW 12TH ST
PENDLETON OR
97801-9411
US

V. Phone/Fax

Practice location:
  • Phone: 541-969-1941
  • Fax:
Mailing address:
  • Phone: 417-399-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2006005127
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20060005127
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: