Provider Demographics
NPI:1295603348
Name:CHATTEN, JACK ANTHONY
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:ANTHONY
Last Name:CHATTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CHERRY LN STE 109
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4397
Mailing Address - Country:US
Mailing Address - Phone:209-210-2727
Mailing Address - Fax:
Practice Address - Street 1:250 CHERRY LN STE 109
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4397
Practice Address - Country:US
Practice Address - Phone:209-210-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician