Provider Demographics
NPI:1164041109
Name:MCCARTHY, CHELSEA MICKE (EAMP (LAC))
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MICKE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:EAMP (LAC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 SW 139TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1220
Mailing Address - Country:US
Mailing Address - Phone:503-935-3147
Mailing Address - Fax:
Practice Address - Street 1:300 E 24TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3214
Practice Address - Country:US
Practice Address - Phone:360-798-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61059489171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist