Provider Demographics
NPI:1619869955
Name:GALLEGOS, CHELSEA (LSWAIC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 S CRESTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2110
Mailing Address - Country:US
Mailing Address - Phone:206-313-2686
Mailing Address - Fax:
Practice Address - Street 1:3013 S MOUNT BAKER BLVD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6139
Practice Address - Country:US
Practice Address - Phone:206-313-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61226104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health