Provider Demographics
NPI:1508527706
Name:ELLSWORTH, CHASIDY JO (MS, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:CHASIDY
Middle Name:JO
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:MISS
Other - First Name:CHASIDY
Other - Middle Name:JO
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC
Mailing Address - Street 1:103 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POINT MARION
Mailing Address - State:PA
Mailing Address - Zip Code:15474-1221
Mailing Address - Country:US
Mailing Address - Phone:724-434-3407
Mailing Address - Fax:
Practice Address - Street 1:630 CHERRY TREE LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8947
Practice Address - Country:US
Practice Address - Phone:724-439-0308
Practice Address - Fax:724-439-0378
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)