Provider Demographics
NPI:1043893431
Name:KEOUGH, CHELSEA (MED, NCC, LAC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:KEOUGH
Suffix:
Gender:F
Credentials:MED, NCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MILL PLAIN RD STE 401
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5114
Mailing Address - Country:US
Mailing Address - Phone:203-903-8042
Mailing Address - Fax:
Practice Address - Street 1:36 MILL PLAIN RD STE 401
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5114
Practice Address - Country:US
Practice Address - Phone:804-220-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00543400101Y00000X
NJ1161617101YS0200X
CT18938420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty