Provider Demographics
NPI:1336908490
Name:KEARL, CHELSEA L (PCSW)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:L
Last Name:KEARL
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:L
Other - Last Name:KEYSAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCSW
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-0676
Mailing Address - Country:US
Mailing Address - Phone:307-438-3384
Mailing Address - Fax:
Practice Address - Street 1:160 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3112
Practice Address - Country:US
Practice Address - Phone:307-438-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-10171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical