Provider Demographics
NPI:1992413926
Name:COLBURN, CHELSEY DANIELLE (LMFT #135622)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:DANIELLE
Last Name:COLBURN
Suffix:
Gender:F
Credentials:LMFT #135622
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SHAW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3839
Mailing Address - Country:US
Mailing Address - Phone:559-712-8500
Mailing Address - Fax:
Practice Address - Street 1:334 SHAW AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3839
Practice Address - Country:US
Practice Address - Phone:559-712-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135622106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist