Provider Demographics
NPI:1275677809
Name:CHD A PROFESSIONAL EDUCATION AND TRAINING CENTER
Entity Type:Organization
Organization Name:CHD A PROFESSIONAL EDUCATION AND TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLARNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:408-985-8115
Mailing Address - Street 1:100 N WINCHESTER BLVD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6520
Mailing Address - Country:US
Mailing Address - Phone:408-985-8111
Mailing Address - Fax:408-985-8113
Practice Address - Street 1:100 N WINCHESTER BLVD
Practice Address - Street 2:SUITE 275
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6520
Practice Address - Country:US
Practice Address - Phone:408-985-8111
Practice Address - Fax:408-985-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health