Provider Demographics
NPI:1134299654
Name:CHELIST, SANDRA (SANDY CHELIST)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CHELIST
Suffix:
Gender:F
Credentials:SANDY CHELIST
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:CHELIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SANDRA CHELIST, LMFT
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-2004
Mailing Address - Country:US
Mailing Address - Phone:303-670-1339
Mailing Address - Fax:
Practice Address - Street 1:3081 BERGEN PEAK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2200
Practice Address - Country:US
Practice Address - Phone:303-670-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist