Provider Demographics
NPI:1235516089
Name:HUTSON, CHELSIE CIERRA
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:CIERRA
Last Name:HUTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9411
Mailing Address - Country:US
Mailing Address - Phone:417-399-4780
Mailing Address - Fax:
Practice Address - Street 1:920 SW FRAZER AVE STE 212
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2802
Practice Address - Country:US
Practice Address - Phone:541-969-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005127101Y00000X
MO20060005127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor