Provider Demographics
NPI:1063689495
Name:MADSEN, CHELSEA AMBER (LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:AMBER
Last Name:MADSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 S STATE ST
Mailing Address - Street 2:STE 28
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5164
Mailing Address - Country:US
Mailing Address - Phone:801-810-6649
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST
Practice Address - Street 2:STE 28
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5164
Practice Address - Country:US
Practice Address - Phone:801-810-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8045992-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist