Provider Demographics
NPI:1316637929
Name:BEACH, CHELSEA FARIS (SWC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:FARIS
Last Name:BEACH
Suffix:
Gender:F
Credentials:SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6265 LANGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1609
Mailing Address - Country:US
Mailing Address - Phone:303-641-0908
Mailing Address - Fax:
Practice Address - Street 1:212 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1004
Practice Address - Country:US
Practice Address - Phone:719-447-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.00000012531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical