Provider Demographics
NPI:1427278084
Name:CHANAS, JESSICA NICOLE (MFT TRAINEE)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:CHANAS
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 DEL NORTE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8366
Mailing Address - Country:US
Mailing Address - Phone:805-981-6950
Mailing Address - Fax:
Practice Address - Street 1:1305 DEL NORTE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8366
Practice Address - Country:US
Practice Address - Phone:805-981-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program