Provider Demographics
NPI:1447039714
Name:BOYD, CHELSIE R
Entity type:Individual
Prefix:
First Name:CHELSIE
Middle Name:R
Last Name:BOYD
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 1:10875 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7699
Mailing Address - Country:US
Mailing Address - Phone:937-360-9525
Mailing Address - Fax:
Practice Address - Street 1:5050 BLAZER PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3230
Practice Address - Country:US
Practice Address - Phone:888-830-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-10-11
Deactivation Date:2023-09-29
Deactivation Code:
Reactivation Date:2023-10-11
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000749003104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker