Provider Demographics
NPI:1912286618
Name:HALE, CHELSEY JO (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:JO
Last Name:HALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:CHELSEY
Other - Middle Name:JO
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1330 RICHLAND DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4089
Mailing Address - Country:US
Mailing Address - Phone:208-521-5755
Mailing Address - Fax:
Practice Address - Street 1:2275 W BROADWAY ST STE G
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-2902
Practice Address - Country:US
Practice Address - Phone:208-524-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-41038104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty