Provider Demographics
NPI:1679125728
Name:GIBSON, CHELSEA (MSED, MPHILED)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MSED, MPHILED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 15TH AVE S STE 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1874
Mailing Address - Country:US
Mailing Address - Phone:206-249-9856
Mailing Address - Fax:
Practice Address - Street 1:4501 15TH AVE S STE 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1874
Practice Address - Country:US
Practice Address - Phone:206-249-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALH61194657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health