Provider Demographics
NPI:1912595273
Name:CHAPUT, MI LIN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MI LIN
Middle Name:
Last Name:CHAPUT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:MI LIN
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2710 N TOWNE AVE UNIT 303
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-6406
Mailing Address - Country:US
Mailing Address - Phone:657-632-4510
Mailing Address - Fax:
Practice Address - Street 1:2545 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6620
Practice Address - Country:US
Practice Address - Phone:888-622-5354
Practice Address - Fax:909-983-1076
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1183731041C0700X
1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912595273Medicaid
CA1912595273OtherNPI
CA1730848383OtherPECOS