Provider Demographics
NPI:1417593393
Name:O'CONNER, CHELSEA BROOKE (LSW)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:BROOKE
Last Name:O'CONNER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:CHELSEA
Other - Middle Name:BROOKE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 E. MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1736
Mailing Address - Country:US
Mailing Address - Phone:419-584-5123
Mailing Address - Fax:567-890-7214
Practice Address - Street 1:1820 C. ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804
Practice Address - Country:US
Practice Address - Phone:419-584-5123
Practice Address - Fax:567-890-7214
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHS.2005105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0416120Medicaid