Provider Demographics
NPI:1710665658
Name:KEATHLEY, CHELSEY NICOLE (MSW)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:NICOLE
Last Name:KEATHLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880
Mailing Address - Country:US
Mailing Address - Phone:304-654-8079
Mailing Address - Fax:
Practice Address - Street 1:351 NEW RIVER RANCH DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-6220
Practice Address - Country:US
Practice Address - Phone:304-574-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical