Basic Information
| Provider Information | |||||||||
| NPI: | 1619060597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUAPOCO | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13822 BELLCREST CT | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925536021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516868500 | ||||||||
| FaxNumber: | 9516868565 | ||||||||
| Practice Location | |||||||||
| Address1: | 10776 FREMONT ST | ||||||||
| Address2: | |||||||||
| City: | YUCAIPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923999630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097970114 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF 52108 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 53845 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.