Provider Demographics
NPI:1912598376
Name:WOODALL, CHELSEA ELIZABETH (MS CPC INTERN)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:ELIZABETH
Last Name:WOODALL
Suffix:
Gender:F
Credentials:MS CPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 RABBIT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3161
Mailing Address - Country:US
Mailing Address - Phone:702-672-8232
Mailing Address - Fax:
Practice Address - Street 1:5450 W SAHARA AVE STE 320
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0383
Practice Address - Country:US
Practice Address - Phone:702-672-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI3115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health