1285013904 NPI number — DR. CHELSEA GRIMSLEY OSWALD PSYD

Table of content: DR. CHELSEA GRIMSLEY OSWALD PSYD (NPI 1285013904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285013904 NPI number — DR. CHELSEA GRIMSLEY OSWALD PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSWALD
Provider First Name:
CHELSEA
Provider Middle Name:
GRIMSLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIMSLEY
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
LAUREN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285013904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W COLEMAN BLVD
Provider Second Line Business Mailing Address:
SUITE 116
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-3588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-801-0135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W COLEMAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-801-0135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2015

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: 103TC2200X , with the licence number:  1433 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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