Provider Demographics
NPI:1427651272
Name:LEATHERMAN, CHELSEA LYNN (LPC)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:LYNN
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 N PARK MEADOW WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1675
Mailing Address - Country:US
Mailing Address - Phone:208-350-8877
Mailing Address - Fax:
Practice Address - Street 1:1032 S BRIDGEWAY PL # 110
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6099
Practice Address - Country:US
Practice Address - Phone:208-246-0123
Practice Address - Fax:208-246-0125
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7818101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor