Provider Demographics
NPI:1205100419
Name:MOYER, CHELSEA SLEETH
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:SLEETH
Last Name:MOYER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:SLEETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1116 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9649
Mailing Address - Country:US
Mailing Address - Phone:831-222-0744
Mailing Address - Fax:
Practice Address - Street 1:6630 HIGHWAY 9 STE 204
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9711
Practice Address - Country:US
Practice Address - Phone:831-222-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97988101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health