Provider Demographics
NPI:1215299680
Name:LIEGEY, CHELSIE PALLETT (MA, CI)
Entity type:Individual
Prefix:MRS
First Name:CHELSIE
Middle Name:PALLETT
Last Name:LIEGEY
Suffix:
Gender:F
Credentials:MA, CI
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 712
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71162-0712
Mailing Address - Country:US
Mailing Address - Phone:318-754-8904
Mailing Address - Fax:
Practice Address - Street 1:725 JORDAN ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4615
Practice Address - Country:US
Practice Address - Phone:318-221-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACI 5191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health