Provider Demographics
NPI:1588911762
Name:CHETIRKIN, TONI-LYNN (LPCC-ATR)
Entity type:Individual
Prefix:
First Name:TONI-LYNN
Middle Name:
Last Name:CHETIRKIN
Suffix:
Gender:F
Credentials:LPCC-ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223504
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93922-3504
Mailing Address - Country:US
Mailing Address - Phone:831-521-1160
Mailing Address - Fax:
Practice Address - Street 1:26485 CARMEL RANCHO BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8706
Practice Address - Country:US
Practice Address - Phone:831-521-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 32101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional