Provider Demographics
NPI:1982482824
Name:SHUPE, CHELSEA ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANN
Last Name:SHUPE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66416-0085
Mailing Address - Country:US
Mailing Address - Phone:785-364-6070
Mailing Address - Fax:
Practice Address - Street 1:202 WILSON AVE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66416-9435
Practice Address - Country:US
Practice Address - Phone:785-364-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12874104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker