MEDICARE: CHELSEY CARREON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor		OK

General Provider Information

NPI Number	:	1497401020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEY CARREON

Provider Business Mailing Address
First Line	:	5100 N BROOKLINE AVE STE 175
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3612
Country	:	US
Telephone Number	:	405-234-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 N BROOKLINE AVE STE 175
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3612
Country	:	US
Telephone Number	:	405-234-5522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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Directions to “ CHELSEY CARREON ” Practice Location

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