Provider Demographics
NPI:1790329134
Name:DICKSON, CHELSEA MICHELLE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MICHELLE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:MICHELLE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510-0679
Mailing Address - Country:US
Mailing Address - Phone:325-893-4010
Mailing Address - Fax:325-893-4035
Practice Address - Street 1:301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TX
Practice Address - Zip Code:76443-2581
Practice Address - Country:US
Practice Address - Phone:254-725-4311
Practice Address - Fax:254-725-4594
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143343363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily