Provider Demographics
NPI:1417685421
Name:CRAINE, CHELSEA JALYNN (LBS)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JALYNN
Last Name:CRAINE
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-2118
Mailing Address - Country:US
Mailing Address - Phone:814-215-3328
Mailing Address - Fax:
Practice Address - Street 1:120 BYRON AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4106
Practice Address - Country:US
Practice Address - Phone:814-201-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006078103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst