Provider Demographics
NPI:1043437270
Name:CHESNUT, ELLEN E (RN LMFT INDIANA)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:E
Last Name:CHESNUT
Suffix:
Gender:F
Credentials:RN LMFT INDIANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 RIBAUT RD
Mailing Address - Street 2:COASTAL EMPIRE COMMUNITY MENTAL HEALTH CENTER
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5400
Mailing Address - Country:US
Mailing Address - Phone:843-524-8899
Mailing Address - Fax:843-524-8179
Practice Address - Street 1:1050 RIBAUT RD
Practice Address - Street 2:COASTAL EMPIRE COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5400
Practice Address - Country:US
Practice Address - Phone:843-524-8899
Practice Address - Fax:843-524-8179
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000689A106H00000X
IN28050102A163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN474537OtherVALUE OPTIONS PIN
IN474537OtherVALUE OPTIONS PIN