1508527706 NPI number — MS. CHASIDY JO ELLSWORTH MS, NCC, LPC

Table of content: MS. CHASIDY JO ELLSWORTH MS, NCC, LPC (NPI 1508527706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508527706 NPI number — MS. CHASIDY JO ELLSWORTH MS, NCC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLSWORTH
Provider First Name:
CHASIDY
Provider Middle Name:
JO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, NCC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRESTON
Provider Other First Name:
CHASIDY
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508527706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POINT MARION
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15474-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-434-3407
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 CHERRY TREE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-439-0308
Provider Business Practice Location Address Fax Number:
724-439-0378
Provider Enumeration Date:
01/10/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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