Provider Demographics
NPI:1275826240
Name:CHIDESTER, CATHY (LPCC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:CHIDESTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 AUTUMN SAGE LANE
Mailing Address - Street 2:
Mailing Address - City:CHAPPRRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-1978
Mailing Address - Country:US
Mailing Address - Phone:575-824-4388
Mailing Address - Fax:
Practice Address - Street 1:204 AUTUMN SAGE LN
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7732
Practice Address - Country:US
Practice Address - Phone:575-824-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0138451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health