Provider Demographics
NPI:1407603939
Name:FLAKES, CHESTER JR
Entity type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:
Last Name:FLAKES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 MCPHERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DOS PALOS
Mailing Address - State:CA
Mailing Address - Zip Code:93620-2654
Mailing Address - Country:US
Mailing Address - Phone:831-800-4072
Mailing Address - Fax:
Practice Address - Street 1:2034 MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:DOS PALOS
Practice Address - State:CA
Practice Address - Zip Code:93620-2654
Practice Address - Country:US
Practice Address - Phone:831-800-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-20-146538106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician