Provider Demographics
NPI:1952022469
Name:SHEA, CHELSEA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6549 BREVARD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7651
Mailing Address - Country:US
Mailing Address - Phone:303-332-4780
Mailing Address - Fax:
Practice Address - Street 1:4210 VALLEY RIDGE BLVD STE 138
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5184
Practice Address - Country:US
Practice Address - Phone:904-560-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health