Provider Demographics
NPI:1275877698
Name:WATERS, CHANTI FRITZSCHING (BCBA)
Entity Type:Individual
Prefix:MS
First Name:CHANTI
Middle Name:FRITZSCHING
Last Name:WATERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CHANTI
Other - Middle Name:
Other - Last Name:FRITZSCHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:591 ASH STREET
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402
Mailing Address - Country:US
Mailing Address - Phone:805-610-8064
Mailing Address - Fax:
Practice Address - Street 1:126 SOUTH H STREET
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-610-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-02-0808103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst