Basic Information
| Provider Information | |||||||||
| NPI: | 1598358079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAFEY | ||||||||
| FirstName: | CHRYSTAL | ||||||||
| MiddleName: | ANN NICOLLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24016 ELROND LN | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926303649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498914654 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20331 FLANAGAN RD. | ||||||||
| Address2: | |||||||||
| City: | TRABUCO CANYON | ||||||||
| State: | CA - CALIFORNIA | ||||||||
| PostalCode: | 92679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185828832 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2021 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1419250221 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.