Provider Demographics
NPI:1134613219
Name:SIMKHADA, CHELSEA (LMSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:SIMKHADA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:877 S KINGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1723
Mailing Address - Country:US
Mailing Address - Phone:617-653-2189
Mailing Address - Fax:
Practice Address - Street 1:890 WASHINGTON AVE STE 150
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7702
Practice Address - Country:US
Practice Address - Phone:616-594-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2021-10-14
Deactivation Date:2021-07-27
Deactivation Code:
Reactivation Date:2021-09-30
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI68011105641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician