Provider Demographics
NPI:1043255110
Name:CHESLEY, RANDALL E (LCSW)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:E
Last Name:CHESLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1331
Mailing Address - Country:US
Mailing Address - Phone:435-462-2416
Mailing Address - Fax:435-462-9350
Practice Address - Street 1:255 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2560
Practice Address - Country:US
Practice Address - Phone:435-896-8236
Practice Address - Fax:435-896-9584
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT136894-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007180Medicare ID - Type UnspecifiedMEDICARE #