Provider Demographics
NPI:1912797028
Name:CHELLBERG, MARY
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:CHELLBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26718 VASHON HWY SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-8319
Mailing Address - Country:US
Mailing Address - Phone:815-847-8055
Mailing Address - Fax:
Practice Address - Street 1:1712 6TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3300
Practice Address - Country:US
Practice Address - Phone:253-473-7586
Practice Address - Fax:253-590-0211
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61675098101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)