Provider Demographics
NPI:1477078442
Name:VANDENKOOY, CHELSEA NICHOLE
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NICHOLE
Last Name:VANDENKOOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 DAPHNE ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4733
Mailing Address - Country:US
Mailing Address - Phone:727-992-4764
Mailing Address - Fax:
Practice Address - Street 1:767 MADISON RD STE 110
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3340
Practice Address - Country:US
Practice Address - Phone:540-738-7720
Practice Address - Fax:540-779-0728
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-18-9306106E00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician