Provider Demographics
NPI:1699456616
Name:GOODRICH, CHELSEA LYN (LPC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LYN
Last Name:GOODRICH
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 1:1131 WOODSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-4957
Mailing Address - Country:US
Mailing Address - Phone:208-309-3614
Mailing Address - Fax:
Practice Address - Street 1:1131 WOODSIDE BLVD
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-4957
Practice Address - Country:US
Practice Address - Phone:208-309-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health