Provider Demographics
NPI:1376028753
Name:TACHELL, CHYVAILA ANNE
Entity Type:Individual
Prefix:
First Name:CHYVAILA
Middle Name:ANNE
Last Name:TACHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 FOSSHOLM ST NE APT A1
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1556
Mailing Address - Country:US
Mailing Address - Phone:971-281-0817
Mailing Address - Fax:
Practice Address - Street 1:329 FOSSHOLM ST NE APT A1
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1556
Practice Address - Country:US
Practice Address - Phone:971-281-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst