Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | CA | |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 051135 | CA |
Y | 101YM0800X | Mental Health Counselor | 29534 | CA |
N | 101YP1600X | Pastoral Counselor | CA | |
N | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1255471231 |
---|---|
Provider Name | Mrs. Ana Luisa Chavez-Mancillas |
First Address | El Monte, CA 91731-1208 |
Second Address | El Monte, CA 91731-1208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 16/11/2010 |