Provider Demographics
NPI:1336877158
Name:SONG, CHELSE (PHD)
Entity type:Individual
Prefix:
First Name:CHELSE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:708 S GAY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6311
Mailing Address - Country:US
Mailing Address - Phone:252-814-4990
Mailing Address - Fax:
Practice Address - Street 1:2855 N SPEER BLVD STE D
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4240
Practice Address - Country:US
Practice Address - Phone:720-943-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist