Basic Information
| Provider Information | |||||||||
| NPI: | 1639792534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHATHAM | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 890 | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767030890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547523451 | ||||||||
| FaxNumber: | 2547563133 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 S 12TH ST | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767011810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547523451 | ||||||||
| FaxNumber: | 2547563133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2020 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.