Doctor Name: | CATHY CHIDESTER |
NPI Number: | 1275826240 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCC |
License Number: | 0138451 |
Business Practice Address: | 204 Autumn Sage Ln Chaparral, NM - 880817732 |
Business Phone Number: | 5758244388 |
Business Fax Number: | |
Mailing Address: | 204 Autumn Sage Lane, CHAPPRRAL |
State: | NM |
Postal Code: | 882021978 |
Phone Number: | 5758244388 |
Fax Number: | |
NPI Enumeration Date: | 05/24/2011 |
NPI Last Update Date: | 11/28/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0138451 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |