Provider Demographics
NPI:1144426859
Name:BOMBEN, CHANDRA KRISTINE (MFTI)
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:KRISTINE
Last Name:BOMBEN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 AGARD ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5102
Mailing Address - Country:US
Mailing Address - Phone:530-314-9771
Mailing Address - Fax:
Practice Address - Street 1:11768 ATWOOD RD STE 106
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9005
Practice Address - Country:US
Practice Address - Phone:530-314-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106H00000X
RAS101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA112196OtherLICENSED MARRIAGE AND FAMILY THERAPIST