Provider Demographics
NPI:1235737156
Name:CHAKOS-KENDER, TIMOTHY (BA, CCIC, CPSS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:CHAKOS-KENDER
Suffix:
Gender:M
Credentials:BA, CCIC, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5338
Mailing Address - Country:US
Mailing Address - Phone:602-274-4343
Mailing Address - Fax:
Practice Address - Street 1:4343 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5338
Practice Address - Country:US
Practice Address - Phone:602-274-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist