Provider Demographics
NPI:1689366890
Name:BROUSE, CHELSEA COLLEEN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:COLLEEN
Last Name:BROUSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:COLLEEN
Other - Last Name:BROUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1110 W PARK PL STE 202
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2783
Mailing Address - Country:US
Mailing Address - Phone:208-244-0120
Mailing Address - Fax:
Practice Address - Street 1:1110 W PARK PL STE 202
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2783
Practice Address - Country:US
Practice Address - Phone:208-244-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-436301041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical