Provider Demographics
NPI:1003404567
Name:CHATTON, SAVANNAH RAY
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:RAY
Last Name:CHATTON
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 1:5870 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8816
Mailing Address - Country:US
Mailing Address - Phone:760-317-8441
Mailing Address - Fax:
Practice Address - Street 1:11130 SAN GABRIEL WAY
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-3122
Practice Address - Country:US
Practice Address - Phone:760-317-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician