Provider Demographics
NPI:1255806824
Name:GREEN, CHELSEA E (QMHP-R)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:QMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SAGINAW ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4121
Mailing Address - Country:US
Mailing Address - Phone:503-589-4046
Mailing Address - Fax:
Practice Address - Street 1:821 SAGINAW ST S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4121
Practice Address - Country:US
Practice Address - Phone:503-589-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2024-01-08
Deactivation Date:2022-07-08
Deactivation Code:
Reactivation Date:2022-08-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health