Provider Demographics
NPI:1124265913
Name:CHASTAIN-HOMICK, ANN (RN, MHR, LPC, BCPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:CHASTAIN-HOMICK
Suffix:
Gender:F
Credentials:RN, MHR, LPC, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N. LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201
Mailing Address - Country:US
Mailing Address - Phone:940-387-6250
Mailing Address - Fax:940-387-6274
Practice Address - Street 1:914 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2954
Practice Address - Country:US
Practice Address - Phone:940-387-6250
Practice Address - Fax:940-387-6274
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional