Provider Demographics
NPI:1306372545
Name:SMITH, CHELSEE TY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEE
Middle Name:TY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 SYCAMORE LINE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4132
Mailing Address - Country:US
Mailing Address - Phone:419-626-9156
Mailing Address - Fax:419-621-0099
Practice Address - Street 1:1634 SYCAMORE LINE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4132
Practice Address - Country:US
Practice Address - Phone:419-626-9156
Practice Address - Fax:419-621-0099
Is Sole Proprietor?:No
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1500371101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor