Provider Demographics
NPI:1699500140
Name:RAINES, CHELSEA M (MPH)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:M
Last Name:RAINES
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:M
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH
Mailing Address - Street 1:2305 ASHLAND ST STE 104-454
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3777
Mailing Address - Country:US
Mailing Address - Phone:541-207-6033
Mailing Address - Fax:
Practice Address - Street 1:221 W MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2728
Practice Address - Country:US
Practice Address - Phone:541-227-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONAPPLICABLE133NN1002X
ORPENDING101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education