Provider Demographics
NPI:1104652403
Name:BREHM, CHELSIE R (SWC)
Entity type:Individual
Prefix:
First Name:CHELSIE
Middle Name:R
Last Name:BREHM
Suffix:
Gender:F
Credentials:SWC
Other - Prefix:
Other - First Name:CHELSIE
Other - Middle Name:R
Other - Last Name:TUBMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 LINDEN CIR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-4725
Mailing Address - Country:US
Mailing Address - Phone:309-642-2223
Mailing Address - Fax:
Practice Address - Street 1:1450 E VALLEY RD UNIT 102
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8352
Practice Address - Country:US
Practice Address - Phone:970-927-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.00000019041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical