Healthcare Provider Details

I. General information

NPI: 1255806824
Provider Name (Legal Business Name): CHELSEA E GREEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date: 07/08/2022
Reactivation Date: 08/01/2022

III. Provider practice location address

223 COMMERCIAL ST NE STE 214
SALEM OR
97301-4082
US

IV. Provider business mailing address

223 COMMERCIAL ST NE STE 214
SALEM OR
97301-4082
US

V. Phone/Fax

Practice location:
  • Phone: 503-877-2035
  • Fax:
Mailing address:
  • Phone: 503-877-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8160
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: