Provider Demographics
NPI:1255799060
Name:PIRES, CHELSEA ROSE (MFTI)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ROSE
Last Name:PIRES
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MCKNIGHT WAY
Mailing Address - Street 2:STE B307
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-9613
Mailing Address - Country:US
Mailing Address - Phone:323-854-1729
Mailing Address - Fax:
Practice Address - Street 1:101 W MCKNIGHT WAY
Practice Address - Street 2:STE B307
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-9613
Practice Address - Country:US
Practice Address - Phone:323-854-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF74588101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health