Provider Demographics
NPI:1003384942
Name:ROSS, CHELSEA J
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:J
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 ASCOT CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-2660
Mailing Address - Country:US
Mailing Address - Phone:415-424-9264
Mailing Address - Fax:
Practice Address - Street 1:2372 MORSE AVE # 534
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6234
Practice Address - Country:US
Practice Address - Phone:949-325-4402
Practice Address - Fax:800-783-6194
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician