Provider Demographics
NPI:1851082234
Name:CHATMAN, CASSANDRA ANN
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANN
Last Name:CHATMAN
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 1:1141 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3208
Mailing Address - Country:US
Mailing Address - Phone:760-499-7406
Mailing Address - Fax:760-499-9259
Practice Address - Street 1:1141 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3208
Practice Address - Country:US
Practice Address - Phone:760-463-2880
Practice Address - Fax:760-499-9259
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X, 390200000X
CAAMFT149271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program