Provider Demographics
NPI:1194090605
Name:PETRAS, CHELSEA JEAN (LADC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JEAN
Last Name:PETRAS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1462
Mailing Address - Country:US
Mailing Address - Phone:763-389-5080
Mailing Address - Fax:763-389-5453
Practice Address - Street 1:1506 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1462
Practice Address - Country:US
Practice Address - Phone:763-389-5080
Practice Address - Fax:763-389-5453
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)