Provider Demographics
NPI:1376257402
Name:BLACKBIRD, CHELSEA (NTP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BLACKBIRD
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:TX
Mailing Address - Zip Code:76950-0381
Mailing Address - Country:US
Mailing Address - Phone:512-496-3083
Mailing Address - Fax:
Practice Address - Street 1:100 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950-2646
Practice Address - Country:US
Practice Address - Phone:512-496-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach