Healthcare Provider Details

I. General information

NPI: 1336617984
Provider Name (Legal Business Name): CHELSEA MAX LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 NE GILMAN BLVD STE 100
ISSAQUAH WA
98027-2940
US

IV. Provider business mailing address

69 LOCH LN SW
LAKEWOOD WA
98499-1472
US

V. Phone/Fax

Practice location:
  • Phone: 425-295-7697
  • Fax:
Mailing address:
  • Phone: 253-576-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: