Provider Demographics
NPI:1124479258
Name:MCCONAHA, CHELSEA (LCSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:MCCONAHA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 BARREN RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-2807
Mailing Address - Country:US
Mailing Address - Phone:859-913-2820
Mailing Address - Fax:
Practice Address - Street 1:148 BARREN RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-2807
Practice Address - Country:US
Practice Address - Phone:859-913-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7668101YM0800X
KY2539491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100588230Medicaid