Provider Demographics
NPI:1144943861
Name:PEDERSON, CHELSEA DALTON (LMSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:DALTON
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132251
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-2251
Mailing Address - Country:US
Mailing Address - Phone:936-337-9477
Mailing Address - Fax:
Practice Address - Street 1:2219 SAWDUST RD STE 1101
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2580
Practice Address - Country:US
Practice Address - Phone:713-806-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108843104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker