Provider Demographics
NPI:1538055843
Name:CHALFANT, MARIA MITTAG
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MITTAG
Last Name:CHALFANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-2304
Mailing Address - Country:US
Mailing Address - Phone:208-508-2202
Mailing Address - Fax:
Practice Address - Street 1:9169 W STATE ST STE 272
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-1733
Practice Address - Country:US
Practice Address - Phone:208-508-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5271359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health