Provider Demographics
NPI:1275728644
Name:CHELOSSI, DEAN ANTHONY (MASTER ART DEGREE)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:ANTHONY
Last Name:CHELOSSI
Suffix:
Gender:M
Credentials:MASTER ART DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 AVALANCHE CT
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-6521
Mailing Address - Country:US
Mailing Address - Phone:775-673-3682
Mailing Address - Fax:
Practice Address - Street 1:650 EDISON WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4100
Practice Address - Country:US
Practice Address - Phone:775-284-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90418575C75059OtherMEDI CAL