Basic Information
| Provider Information | |||||||||
| NPI: | 1174041016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | CHAISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 W WEST COVINA PKWY | ||||||||
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| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269740770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1215 W WEST COVINA PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269740770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2017 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.