Provider Demographics
NPI:1487169454
Name:MOORE, CHELSEA (LPC,CRC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC,CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2903
Mailing Address - Country:US
Mailing Address - Phone:937-903-0280
Mailing Address - Fax:
Practice Address - Street 1:2570 TECHNICAL DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-6107
Practice Address - Country:US
Practice Address - Phone:937-847-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OHC.2204533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician