Provider Demographics
NPI:1235622713
Name:FOREMAN, CHELSEA (LLMSW)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 W ST JOE HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4028
Mailing Address - Country:US
Mailing Address - Phone:517-323-4099
Mailing Address - Fax:517-323-3334
Practice Address - Street 1:5123 W ST JOE HWY STE 103
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4028
Practice Address - Country:US
Practice Address - Phone:517-323-4099
Practice Address - Fax:517-323-3334
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801102739Medicaid