Provider Demographics
NPI:1689172249
Name:WIRTZ, CHELSEY BAE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:CHELSEY
Middle Name:BAE
Last Name:WIRTZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:CHELSEY
Other - Middle Name:BAE
Other - Last Name:WIRTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHELSEY WIRTZ, LPCC
Mailing Address - Street 1:2835 EMERSON AVE S APT CN424
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1388
Mailing Address - Country:US
Mailing Address - Phone:218-849-5868
Mailing Address - Fax:
Practice Address - Street 1:1854 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1403
Practice Address - Country:US
Practice Address - Phone:612-424-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health