Provider Demographics
NPI:1720384704
Name:ROTH, CHELSEA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:LYNN
Last Name:ROTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10656 JEFFREY WAY
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2521
Mailing Address - Country:US
Mailing Address - Phone:530-913-0307
Mailing Address - Fax:
Practice Address - Street 1:10833 DONNER PASS RD STE 201
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4851
Practice Address - Country:US
Practice Address - Phone:530-582-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5506-S104100000X
NV8771-C1041C0700X
CA285251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker