Provider Demographics
NPI:1104964469
Name:CHANCE, CATHY A (PHD)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:CHANCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4350
Mailing Address - Country:US
Mailing Address - Phone:951-652-6320
Mailing Address - Fax:951-652-9355
Practice Address - Street 1:119 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4350
Practice Address - Country:US
Practice Address - Phone:951-652-6320
Practice Address - Fax:951-652-9355
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12827103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33BEFWMedicaid
CA33BE5WMedicaid
CA33BE5WMedicaid